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Spasticity: Definition, Causes, Symptoms, Care

Generality

Spasticity is a disorder that involves excessive and abnormal increase in muscle tone. More precisely, spasticity is characterized by spasms of one or more skeletal muscles and an increase in the tone of the stretch reflexes.

Generally, spasticity is the clinical sign of serious underlying diseases, which may have different origins and nature.

Spasticity is a highly debilitating condition, the consequences of which can also be serious; hence the importance of identifying the treatment that best fits the characteristics of each patient, so as to improve their quality of life as much as possible.

Causes

Spasticity is a clinical sign resulting from serious conditions and / or underlying diseases. Among the main causes that can cause the onset of this disorder, we recall:

  • Multiple sclerosis;
  • Cerebral palsy;
  • Spinal cord injury;
  • Brain stroke.

Symptoms and Consequences

As mentioned above, spasticity usually constitutes the symptom of an underlying pathological condition. However, this disorder is frequently associated with other symptoms, such as painful spasms and muscle weakness.

In patients suffering from spasticity, slight impairment of motility can occur, up to complete loss of skeletal muscle control. In the latter case, we can talk about:

  • Monoparesis, when the motor deficit affects only one limb;
  • Paraparesis, if the motor deficit affects both lower limbs;
  • Tetraparesis, when the motor deficit affects all four limbs and, in some cases, also the muscles of the trunk and neck;
  • Hemiparesis, when the motor deficit affects only one side of the body.

Finally, spasticity can lead to serious consequences, such as: balance disorders, ataxia, dysarthria, difficulty swallowing, tendon shortening, muscle retraction and joint deformation.

Diagnosis

The diagnosis of spasticity must be made by the doctor, who will proceed by evaluating the resistance that the skeletal muscles oppose to passive movements.

Usually, the evaluation of this resistance is carried out using an instrument called " Ashworth scale " which - assigning a number between 0 and 4 - classifies the anomalies of skeletal muscle tone in the following way:

  • 0: no change in muscle tone during mobilization;
  • 1: moderate increase in muscle tone with "step sensation" when the limb is flexed or extended;
  • 2: evident increase in muscle tone, in which, however, mobilization is still possible;
  • 3: considerable increase in muscle tone, in which mobilization is difficult;
  • 4: fixed contraction in extension or flexion.

Treatment

As we have seen, spasticity is a disorder that can adversely affect the quality of life of patients who suffer from it; for this reason its treatment is fundamental.

Generally, multiple therapeutic strategies are used simultaneously. More in detail, a basic pharmacological therapy is accompanied by various physiotherapy treatments, aimed at strengthening healthy muscles and mobilizing, as far as possible, those affected by spasticity.

Pharmacological treatment, on the other hand, is symptomatic and serves mainly to relieve the patient of pain, which is often associated with spasticity, and to facilitate the development of physiotherapy.

Among the main antispastic drugs of skeletal muscles currently used in therapy, we recall:

  • Diazepam (Valium® solution for injection), a benzodiazepine that is used in the treatment of various disorders, but which is also used to treat spasticity due to spinal cord injury, or caused by cerebral palsy. However - at the doses that must be administered to significantly reduce skeletal muscle tone - diazepam causes side effects, such as drowsiness and fatigue, in most patients.
  • Baclofen (Lioresal®), this active ingredient is used in the treatment of spasticity caused by multiple sclerosis and traumatic spinal cord injuries, and is used especially in the case of paraparesis and tetraparesis.

    The peculiarity of baclofen is that it can be administered both orally and intrathecally. In the latter case, a subcutaneous infusion pump and a catheter are surgically implanted which will arrive at the intrathecal level, where the drug will be released at predetermined intervals.

    The advantage of the latter mechanism of administration of baclofen consists in a reduction of the side effects that occur when the drug is administered orally. These side effects are: sedation, psychological disorders, dizziness and marked weakness.

  • Tizanidine (Sirdalud®), this active ingredient is a muscle relaxant drug widely used for the treatment of spasticity associated with multiple sclerosis, but not only. In fact, tizanidine is also used in the treatment of spasticity due to spinal cord injury or disease, or due to stroke.

    Tizanidine is administered orally and the main side effects that can occur following its intake are: sedation, muscle weakness, dizziness, hypotension and bradycardia.