Dealing with the symptom of spasticity
Spasticity is a symptom of many diseases and can have a huge impact on quality of life. Treatments range from physiotherapy to intrathecal baclofen pumps.
Evelyn Frank gives an overview
Spasticity is not a disease but a feature of some common neurological disorders, such as multiple sclerosis (MS), stroke and cerebral palsy, and spinal cord or brain injury. It is characterised by an “involuntary, velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks”.
The tonic stretch reflex causes muscle contraction (muscle tone) in response to stretching. In spasticity, muscles are continuously contracted, resulting in stiffness and resistance to movement or positioning. The faster the affected part is moved the more resistance is encountered.
Movement (including walking), balance and speech can be affected, with huge impact on everyday life.
For example, patients can have problems picking up objects, washing, dressing, sleeping and engaging in sexual activity, all of which can affect mood and self image. Severe spasticity is also commonly associated with pain, skin breakdown (eg, pressure sores) and bone deformation.
To read the full article download the attached PDF (840K)
Evelyn Frank, ClinPharmDip, MRPharmS, senior pharmacist at the National Hospital for Neurology and Neurosurgery
The Royal Pharmaceutical Society guidance on Sativex, including advice on storage and record making
In spasticity, muscles are continuously contracted, leading to difficulties with everyday activities, pain and deformity.
Before treating spasticity, its duration, extent and location, and underlying conditions should be considered. Realistic patient goals should be established. Treatment can worsen patient outcomes.
Precipitating factors, such as fatigue, extremes of temperature and infection, should be avoided.
Stretching exercises are the cornerstone of treatment.
Baclofen, diazepam and tizanidine are commonly used but the evidence base is poor. They seem to be equally effective.
The side effect profile (hepatotoxicity) of dantrolene limits its use.
Sativex is only licensed to treat multiple sclerosis related spasticity.
Botulinum toxin and phenol are used in focal spasticity.
Citation: The Pharmaceutical Journal URI: 11071319