Spasticity
Spasticity is the stiffening or tightening of the muscles. The condition involves the muscles being contracted and resistant to stretching.
What’s in this section?
Signs and Symptoms
The most common symptoms of spasticity include the following:
- Difficulty with movement due to muscle stiffness
- Uncontrollable and painful muscle spasms
- Muscle or joint deformities
- Fatigue of the muscles
- Involuntary leg crossing
- Increased muscle tone
- Overactive reflexes
Potential Causes
The imbalance of signal from the central nervous system (brain and spinal cord) to the muscles they serve is the primary reason for spasticity. This is most often seen in those with cerebral palsy, multiple sclerosis, traumatic brain or spine injuries, or following a stroke.
Diagnosis
Diagnosis starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose, including a detailed neurological exam , electroencephalogram ( EEG ), blood tests, computed tomography ( CT ) and magnetic resonance imaging ( MRI ).
Other conditions can cause the same symptoms, so it is important to check with your doctor for an accurate diagnosis. Only a doctor experienced in recognizing the exact combination of symptoms that indicate spasticity can make a firm diagnosis.
Treatment Options
There are a few different treatment options depending on the severity of symptoms:
- Physical or occupational therapy
- Bracing
- Medication
- Botox
- Intrathecal baclofen pump An intrathecal pump or a “pain pump” delivers small amounts of medicine (baclofen) into the spinal fluid. By giving baclofen in smaller doses, the side effects are lessened. The process is a direct way of treating the dysfunction in the spinal cord with much more powerful therapy and is very effective for most forms of spasticity when other therapies are unable to control it.
This usually takes two surgeries. During the first surgery, a catheter is placed and used to test the baclofen and its effectiveness. During the second surgery, this catheter is connected to the pump, which delivers the medication. This is done using a lumbar puncture or drainage catheter. The patient will be asleep. Using an X-ray machine in the operating room, the doctor will locate the best entry point to place a special needle in the lumbar (back) area, and then place a catheter into the spinal fluid with a small incision (similar to epidural anesthesia). Using a larger incision, a pump about the size of a hockey puck is placed in the abdomen. Then tubing is placed under the skin between the two incisions to connect the pump to the spinal fluid.
After surgery, the patient will be kept flat for two days to help prevent a spinal fluid leak. The pump will be set to deliver drug therapy to the patient just after surgery and can be adjusted as needed.
- Rhizotomy. Radiofrequency ablation (rhizotomy) is a procedure where high frequency radio waves are used to generate heat and cause a lesion along a nerve that supplies sensation to a joint in your spine. This procedure is performed by a physician certified in anesthesia and pain medicine using live x-ray in either the office or surgery center setting.
This procedure typically takes about 20–30 minutes and may be performed either with local anesthetic, oral sedation or IV sedation in the surgery center, depending on patient preference. An area of your skin will then be cleaned/sterilized, which may feel cold. You will then feel an injection with a small needle into your skin to numb the area.
The procedure involves a special needle that is advanced to the target area under fluoroscopic (X-ray) guidance. A small amount of electrical current is used to demonstrate proper placement along the targeted nerve. You will feel a buzz or tapping sensation, but it typically isn’t painful. Once the needle has been properly placed, a local anesthetic will be placed into the targeted area. The radiofrequency ablation will then be performed, which typically lasts a few minutes. A combination of local anesthetic and injectable steroids are then injected before the needle is removed.
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