What is spasticity?
Spasticity is a symptom present in various neurological diseases. It is an increase in the tone of one or more muscles, which prevents them from relaxing. This causes forced postures: in the upper limb it can cause the shoulder to be glued to the body, the elbow and wrist to flex or the hands to close; in the lower limb, it causes flexion of the hip and knee, the appearance of clubfoot (with the tip of the foot drooping) or the big toe raised. Occasionally, involuntary contractions or spasms also appear.
What are the causes?
Spasticity can have its origin in any disease of the central nervous system, cerebral or spinal cord. In this case there is an alteration of the stretching reflex of the muscles, which therefore do not relax as they normally would after their contraction. Some of the diseases that produce spasticity are stroke (hemiplegia), spinal cord injury (both paraplegia and tetraplegia), multiple sclerosis, traumatic brain injury, or infantile cerebral palsy, among others.
What are the symptoms?
The symptoms of spasticity are diverse, as they depend on the intensity of the disorder and the muscles affected (it is not the same if there is spasticity in only one limb than if it is present in a large part of the musculature).
In general, the most common symptoms are pain and limitation of the functionality and independence of the person suffering from the disorder.
When present in the upper limb it causes shoulder pain and the patient also has difficulties in the hygiene of his armpits, because he cannot separate the arm sufficiently. For the same reason, he will not be able to clean his hands or cut his nails properly. This involuntary lack of hygiene can cause infection in the hands or armpit. He will also have difficulty dressing and undressing because he will not be able to move his shoulder or elbow joints.
As for the lower limb, the ability to walk is affected (e.g., the drooping toe in cases of clubfoot causes habitual falls as the patient can easily stumble). When the adductor muscles are affected there are difficulties in this regard as the legs cross involuntarily. This also makes genital and perianal hygiene difficult and also makes sexual intercourse difficult.
Spastic patients also have many difficulties in correctly positioning both upper and lower limb orthoses. This causes abnormal joint positions to be maintained.
How should it be treated and is there a cure?
Spasticity does not have a definitive cure, since it is a symptom and not a disease. As it is caused by an irreversible neurological lesion, the damage produced by it remains in time.
However, it has an effective treatment. The type of therapy used is different depending on the number of muscles affected.
When spasticity is focal (i.e. it affects only a few muscles in the body), the most appropriate treatment is infiltration with botulinum toxin. This substance is injected directly into the muscle and produces its relaxation. Its efficacy translates into an improvement in the quality of life of both the patient himself and his caregivers, since they can passively and easily move joints in which previously mobility was practically impossible.
The relaxation of the musculature with botulinum toxin injection reduces the pain caused by the sustained contraction of the affected musculature and, secondarily, improves the quality of sleep and the way of sitting or lying down. It also tends to improve the ease of dressing and undressing, hygiene, etc.
The effect of botulinum toxin is temporary: it lasts about three or four months, so to maintain the therapeutic effects it is necessary to perform periodic injections.
It is a safe drug when used by specialist doctors (rehabilitation specialists or neurologists) who are experts in neurorehabilitation. The experience in the use of botulinum toxin both in Spain and in the rest of the world is more than 25 years. During this time its efficacy and the scarcity of undesirable effects have been documented.
When spasticity is generalized, that is to say, when it affects most of the muscles of the body, the isolated use of botulinum toxin is not usually sufficient, since it would no longer be safe.
In these cases the treatment of choice is therapy with intrathecal baclofen, if oral therapy has failed (which is often the case). It consists of the surgical implantation of a system that directly administers the medication (baclofen) into the central nervous system. This reduces generalized spasticity and has great benefits for the quality of life of the patient and his or her caregivers.
Sometimes both therapies (botulinum toxin and intrathecal baclofen pump) are combined to achieve better results.