Spasticity

Answer 1

Definition

Spasticity is stiff or rigid muscles with exaggerated, deep tendon reflexes (for example, a knee-jerk reflex). The condition can interfere with walking, movement, or speech.

See also: Muscle cramps

Alternative Names

Muscle stiffness

Considerations

Spasticity generally results from damage to the part of the brain that controls voluntary movement. It may also occur when you have damage to the nerves traveling from brain down to spinal cord.

Symptoms of spasticity include:

• Exaggerated deep tendon reflexes (the knee-jerk or other reflexes)
• Scissoring (crossing of the legs as the tips of scissors would close)
• Repetitive jerky motions (clonus), especially when touched or moved
• Unusual posturing
• Carrying the shoulder, arm, wrist, and finger at an abnormal angle due to tightness of the muscle

Spasticity may also interfere with speech. Severe, long-term spasticity may lead to contracture of muscles, causing joints to be bent at a fixed position.

Common Causes

• Cerebral palsy
• Brain damage caused by lack of oxygen, as can occur in near drowning or near suffocation
• Brain trauma
• Severe head injury
• Spinal cord injury
• Stroke
• Adrenoleukodystrophy
• Phenylketonuria
• Neurodegenerative illness
• Multiple sclerosis

This list is not all-inclusive.

Home Care

Exercise, including muscle stretching, can help make your symptoms less severe. Home-based physical therapy is also helpful

Call your health care provider if

Contact your health care provider if:

• The spasticity worsens
• Contracture deformities appear to be developing

What to expect at your health care provider's office

Your doctor will perform a physical exam and ask questions about your symptoms, including:

• When was it first noticed?
• How long has it lasted?
• Is it always present?
• How severe is it?
• What muscles are affected?
• What makes it better?
• What makes it worse?
• What other symptoms are also present?

Your doctor may refer you to a physical therapist. Physical therapy consists of variety of exercises, including muscle stretching and strengthening exercises. Physical therapy exercises can be taught to parents who may then help their child perform them at home.

Medicines for spasticity include baclofen, tizanidine, cyclobenzaprine, and benzodiazepines. In rare cases, a pump may be inserted into the spinal fluid to directly deliver medicine to the nervous system.

Botox injections may help relieve spasticity symptoms in some patients.

Sometimes, a person may need surgery to release the tendon or to cut the the nerve-muscle pathway.

References

Griggs R, Jozefowicz R, Aminoff M. Approach to the patient with neurologic disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 418.

Hammerstad J. Strength and reflexes. In: Goetz, CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 15.

Answer 2

Definition

Spasticity is stiff or rigid muscles. It may also be called unusual "tightness" or increased muscle tone. Reflexes (for example, a knee-jerk reflex) are stronger or exaggerated. The condition can interfere with walking, movement, or speech.

See also: Muscle cramps

Alternative Names

Muscle stiffness; Hypertonia

Considerations

Spasticity is usually caused by damage to the part of the brain that is involved in movements under your control. It may also occur from damage to the nerves that go from the brain to the spinal cord.

Symptoms of spasticity include:

• Abnormal posture
• Carrying the shouler, arm, wrist, and finger at an abnormal angle because of muscle tightness
• Exaggerated deep tendon reflexes (the knee-jerk or other reflexes)
• Repetitive jerky motions (clonus), especially when you are touched or moved
• Scissoring (crossing of the legs as the tips of scissors would close)

Spasticity may also affect speech. Severe, long-term spasticity may lead to contracture of muscles, which can reduce range of motion or leave the joints bent.

Common Causes

• Adrenoleukodystrophy
• Brain damage caused by lack of oxygen, as can occur in near drowning or near suffocation
• Cerebral palsy
• Head injury
• Multiple sclerosis
• Neurodegenerative illness -- illnesses that damage the brain and nervous system over time
• Phenylketonuria
• Spinal cord injury
• Stroke

This list does not include all conditions that can cause spasticity.

Home Care

Exercise, including muscle stretching, can help make your symptoms less severe. Home-based physical therapy is also helpful.

Call your health care provider if

Contact your health care provider if:

• The spasticity gets worse
• You notice deformity of the affected areas

What to expect at your health care provider's office

Your doctor will perform a physical exam and ask questions about your symptoms, including:

• When was it first noticed?
• How long has it lasted?
• Is it always present?
• How severe is it?
• What muscles are affected?
• What makes it better?
• What makes it worse?
• What other symptoms are present?

Your doctor may refer you to a physical therapist. Physical therapy involves different exercises, including muscle stretching and strengthening exercises. Physical therapy exercises can be taught to parents who may then help their child do them at home.

Medicines for spasticity include baclofen, benzodiazepines (such as diazepam), clonidine, dantrolene, gabapentin, and tizanidine. Botulinum toxin can be injected into the spastic muscles. In rare cases, a pump may be inserted into the spinal fluid to directly deliver medicine to the nervous system.

Sometimes, a person may need surgery to release the tendon or to cut the nerve-muscle pathway.

References

Dobkin BH. Principles and practices of neurological rehabilitation. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 52.

Griggs R, Jozefowicz R, Aminoff M. Approach to the patient with neurologic disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 418.

Reviewed By

Review Date: 02/05/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.