Spasticity in MS – an Introduction
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Much of the information in this article has been drawn from the MSIF publication “MS in FOCUS” Issue 12
Spasticity, ( feelings of muscle stiffness and involuntary muscle spasms), is a well defined consequence of MS.
It is recognised through various studies that spasticity occurs frequently in people with MS with Male gender, older age, and longer duration of the disease showing an increased severity of spasticity.
Quality of life can be affected with troublesome symptoms and functional limitations, and severe spasticity may even lead to medical complications such as skin breakdown or contractures, where a limb can become fixed in one position. So, as you can see, there is a need to recognise and address spasticity and its consequences.
In many cases, initial interventions such as stretching, exercise and rehabilitation are helpful, but
they also enhance the efficacy of other interventions such as medication. Medications can be useful and are usually safe, although the dosing and timing must be optimised to minimise potential side effects.
For some individuals a degree of spasticity serves as a functional crutch and helps them to walk or carry out other physical activities, so the biggest challenge with spasticity management is determining what the optimal level of muscle tone is for an individual.
What’s going on?
What is happening with the nervous system to cause spasticity? To explain this you must review the fact that there are two types of motor neurones.
The nerve pathway connecting the brain and spinal cord is made of upper motor neurones. The pathway between the spinal cord and muscles is made of lower motor neurones. Spasticity is a consequence of an “upper motor neuron (UMN) syndrome”. The interruption of signals caused by MS lesions means that the upper motor neurones can no longer regulate messages to the lower motor neurones. The lower motor neurones can then become overactive and hypersensitive, causing stiffness or spasms in the muscles.
Some of the detrimental consequences associated with spasticity are:
- interference with mobility, ability to exercise and the range of motion in joints
- negative impact on endurance and energy expenditure
- interference with the activities of daily living
- discomfort or pain
- sleep disturbance
- increased difficulty for caregivers (for example with transfers or hygiene).
Treating Spasticity .
Hot temperatures may cause a decrease in spasticity for people with MS while infections and exacerbations may cause a significant increase in spasticity. The cause of any change must first be identified. If it is due to an infection, it is crucial that the infection be treated first. Many people with MS recognise increased spasticity as a sign of a bladder or other infection, or of the increase in core body temperature that is associated with a fever or excessive exercise, or of a full bladder or colon.
When treating spasticity it is important to focus the aim on management and not necessarily on the elimination of the spasticity since some individuals use their spasticity to assist with functional movements. In addition, for individuals who have restricted movement, spasticity may help promote circulation by maintaining muscle contractions which can promote the return of blood to the heart.
The most important principle of treating spasticity is to develop reasonable and flexible goals that target specific manifestations of spasticity – pain, fatigue, stiffness or weakness – and, together with the person with MS, frequently reassess the effectiveness of treatments.
Spasticity can affect just a few parts of the body (focal spasticity), or it can manifest in multiple places (generalised spasticity). It can range from insignificant to incapacitating, with many levels in between. Spasticity can also increase and decrease.
Other causes of increased spasticity include:
- noxious stimuli such as a skin lesion
- a bladder or kidney stone
- fractures
- tight clothing
- menstruation
- psychological stress
- extreme environmental temperature
- hunger
- an MS exacerbation
- treatment with some disease modifying or antidepressant pharmaceutical agents.
In the next article I will be dealing with the treatments used in spasticity
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