Spasticity

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Spasticity is a common finding in those with MS. It is defined as velocity-dependent stiffness about a joint. The muscle stiffens the faster it is moved. Spasticity is not inherently a bad symptom. Many patients use lower-limb spasticity to generate gait or transfers. Sometimes, however, it can become very bothersome and needs significant attention. Noxious stimuli anywhere in the body will exacerbate spasticity. Thus, the first attempt at treatment revolves around eliminating pain in the body. This may be from a urinary tract infection or from a sore. After pain is treated, an exercise program is instituted. This usually concentrates on the stretching and range of motion exercises, but aerobic exercises can be effective also. Physical therapists may be involved in the initiation of the process. The actual exercising should be as independent as possible so that the person can do it easily on a regular basis.

A variety of medications are helpful for spasticity. Baclofen is the most commonly used pharmacologic agent and may be dosed from 5 mg to 160 mg each day, depending on the severity of the spasticity and the tolerance of the medication. Side effects include trading weakness for spasticity.

Tizanidine from doses of 2 mg to 36 mg is also frequently used but causes sedation and dry mouth, which often limits its use. Benzodiazepines (diazepam and clonazepam) relieve spasticity but are quite sedating and may be habit-forming. They are best used for nocturnal spasms. A variety of newer antiepileptic treatments, including gabapentin and topiramate, may add additional help for those in whom the standard antispasticity regimens are not successful.

For those with intractable spasticity, a "high-tech" approach is necessary. Cutting tendons, ligaments, and the spinal cord is, for the most part, a thing of the past. Sometimes, the injection of botulinum toxin (Botox) can relieve the muscle stiffness, but often the dose is too high to be effective without causing side effects. Canniboids are thought by some to be of value in treating difficult spasticity, but they have never been found to be effective in a well-conceived study. The baclofen pump allows for the administration of baclofen intrathecally, where it is most effective, in microgram aliquots. This can relieve almost any spastic-ity if dosed appropriately.

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