What Is Spasticity? Symptoms, Causes, and Treatment Methods

What Is Spasticity? What Are Its Symptoms? How Is It Diagnosed and Treated?

What is spasticity? It is a condition characterized by involuntary muscle contractions that occur when the signals sent by the nervous system to the muscles are disrupted. It is a movement disorder affecting more than 12 million people worldwide.

Spasticity symptoms generally manifest as muscle stiffness and spasms. This condition can occur as a result of many diseases affecting the brain and/or spinal cord, such as cerebral palsy, traumatic brain injury, stroke, spinal cord injury, and multiple sclerosis. Early diagnosis and appropriate treatment can minimize the negative effects of spasticity.

In this article, you will find answers to questions about what spasticity disease is, what symptoms it has, and which systems it affects. You will also gain information about the methods used for spasticity treatment. Thus, you can better understand what you can do if you or a loved one encounters this condition.

What is spasticity?

Spasticity, which occurs as a result of damage to the central nervous system, is a condition characterized by out-of-control contractions in the muscles. Coming from the Greek word "spasticus", this term means "to pull" and refers to the condition where muscles uncontrollably pull and remain contracted.

What is spasticity disease?

Spasticity is a movement disorder caused by damage to the nerve pathways in the brain or spinal cord that control muscle movement. This condition manifests itself with muscles being more tense, stiff, or involuntarily contracted than normal. In individuals with spasticity, the inhibition of the ability of muscles to lengthen can lead to restricted joint movements and deformities over time.

Spasticity can occur in different forms, such as spastic contraction, tonic contraction (the whole body all at once), or clonic contraction (twitching). This condition makes it difficult to perform daily activities and can seriously reduce the quality of life.

Is spasticity a disease or a symptom?

Spasticity is actually not a disease, but a symptom related to damage in the brain, spinal cord, or motor nerves. It usually manifests as a sign of another neurological disorder. It affects more than 12 million people worldwide and is seen in approximately 80% of people with cerebral palsy and 80% of individuals with multiple sclerosis.

Some diseases that trigger this condition are:

Cerebral palsy (CP)

Multiple sclerosis (MS)

Stroke

Traumatic brain or spinal cord injury

Amyotrophic lateral sclerosis (ALS)

Hereditary spastic paraplegias

Metabolic diseases (Adrenoleukodystrophy, Phenylketonuria, Krabbe disease)

Which systems are affected?

Spasticity primarily affects the muscular and nervous systems. When communication between motor neurons in the brain and spinal cord and the muscles is disrupted, problems arise in the normal contraction and relaxation mechanism of the muscles. This causes stiffness, involuntary contractions, and movement limitation, especially in the muscles of the arms and legs.

When spasticity is not controlled, it can affect not only the muscular and nervous systems but also joint and bone structures. Long-standing muscle contractions and stiffness can lead to restricted joint movement and permanent deformities over time.

What are the symptoms of spasticity?

The symptoms of spasticity in our body significantly affect the daily life of many people. These symptoms stem from the disruption of communication between the nervous system and muscles and can limit individuals' mobility.

Muscle stiffness and spasms

The most common symptom in spasticity is excessive stiffness in the muscles. Affected muscles may feel more tense, hard, and tight than normal. This condition occurs as a result of involuntary muscle contraction. Sudden and involuntary contractions called muscle spasms can often be painful and can lead to severe muscle aches sufficient to cause a person to suddenly stop moving or wake up from nighttime sleep.

Spasms usually last from a few seconds to a few minutes. A noticeable feeling of hardness occurs in the muscles when touched, and muscle twitching can also be seen in some cases. Additionally, individuals may feel as if their muscles are jumping or moving.

Movement limitation and fatigue

Due to excessive muscle tension, joint mobility can be severely restricted. This condition can cause functional losses by making it difficult for the person to lead an independent life. Depending on spasticity, muscles can remain in a state of involuntary contraction for a long time, and this condition prevents muscle fibers from resting, leading to a loss of strength over time.

Along with the rapid depletion of energy reserves, fatigue increases and muscle endurance decreases significantly. As a result, individuals have difficulty performing their daily activities, and every movement causes them to expend more energy.

Abnormal reflexes and posture disorders

Exaggerated deep tendon reflexes, clonus (rapid muscle contractions), and involuntary crossing of the legs (scissoring) are among the common symptoms in spasticity. Motor neuron damage can cause unbalanced tensions between muscles, leading to impairments in body posture.

Balance problems are also significant symptoms of spasticity. Because it makes muscle control difficult, it can affect a person's ability to stand and walk. This condition manifests itself with the loss of gait pattern and uncontrolled movements. These incorrect patterns that develop over time can cause permanent deformities in the musculoskeletal system.

Special symptoms seen in children

Unlike adults, spasticity in children can lead to growth problems. Since muscle stiffness and spasms prevent the child's normal growth and development, they can cause painful and deformed joints.

The severity of spasticity can vary from person to person. It can be seen in a wide range from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms. Especially in children, early diagnosis and treatment are of great importance in terms of preventing permanent disabilities.

What causes spasticity? Underlying diseases

Damage to nerve cells in the brain or spinal cord is the primary cause of spasticity. This damage can occur as a result of various diseases or injuries. So what are these conditions that lead to spasticity?

Cerebral palsy and birth traumas

Cerebral palsy is one of the most common causes of spasticity, and children with spastic cerebral palsy account for approximately 60% of all cerebral palsy cases. It stems from damage to the motor control regions of the brain before, during, or after birth.

Birth complications, premature birth (especially before 28 weeks), and low birth weight are factors that increase the risk of cerebral palsy for babies. Damage affecting brain development up to the first two years after birth can also lead to cerebral palsy.

Multiple sclerosis and neurological diseases

Multiple sclerosis (MS) is a progressive disease that develops as the immune system attacks the protective sheath surrounding nerve cells. This disruption in nerve conduction results in muscle stiffness and spasticity. This condition, which is seen more frequently especially in the primary progressive form of MS, can seriously affect patients' daily quality of life.

Other neurological diseases, such as amyotrophic lateral sclerosis (ALS), can also cause spasticity. These diseases disrupt the function of motor neurons, leading to a loss of muscle control.

Spinal cord and brain injuries

Traumatic brain injury occurs as a result of blows to the head or penetrating injuries. Such damage can affect your ability to think, feel, and move. Spasticity developing within the first 6 months after a brain injury can disrupt the flow of nerve messages between the brain and muscles.

Spinal cord injuries are also common causes of spasticity. Following these injuries, uncontrolled contractions and stiffness can be seen in the muscles below the injured level. While this condition makes standing and daily activities easier for some people, it can be painful and restrictive for others.

Spasticity can also develop in patients who have had a stroke. It usually does not appear in the early period of the disease, but rather in the following months, and is more common in strokes due to brain hemorrhage.

Genetic and metabolic causes

Hereditary spastic paraplegias are a group of diseases caused by gene mutations, presenting with muscle weakness in the legs and spasticity. Seen in 1 to 10 per 100,000 people, more than 70 gene mutations have been identified to date for this condition.

These gene mutations disrupt the structure, nutrition, and intercellular communication of nerve cells, causing spasticity symptoms to appear. The most common type is autosomal dominant inheritance, which constitutes 75-80% of patients.

Metabolic diseases such as adrenoleukodystrophy (ALD), Krabbe disease, and phenylketonuria can also lead to spasticity. These diseases affect the normal metabolism of nerve cells, disrupting muscle tone control.

How is spasticity diagnosed?

In order for spasticity to be treated correctly, it must first be diagnosed accurately. The diagnostic process usually begins with neurology specialists listening to the patient's complaints and continues with various examinations.

Physical examination and patient history

The first step in diagnosing spasticity is to take a detailed patient history and perform a comprehensive physical examination. The doctor asks when your complaints started, their severity, and how they affect your daily life. At the same time, they gather information about diseases or injuries you have previously experienced.

During the physical examination, the doctor evaluates your muscle tone, muscle strength, and reflexes. They check your body posture by examining your movements such as sitting, standing, and rising. Deep tendon reflexes and muscle tension are evaluated with particular care. This examination is important to determine the severity of spasticity and which muscles are affected.

Muscle tone assessment is one of the most fundamental stages in diagnosing spasticity. The patient's life history, duration of complaints, and difficulties in movements are questioned in detail. This information serves as a guide for creating the subsequent treatment plan.

EMG and nerve conduction studies

EMG (electromyography) looks at the electrical signals that muscles produce while at rest or in use. Thanks to this test, it is determined whether the cause of the disease is in the muscles or in the nerves supplying the muscles. The EMG test is performed to diagnose diseases occurring in the muscle and nerve structure.

The EMG procedure consists of two stages:

Surface EMG where electrodes are attached to the skin

Needle EMG where a needle electrode enters the muscle

Nerve conduction studies evaluate the speed at which nerves transmit impulses to muscles. These tests are used to determine the extent of nerve damage causing spasticity. EMG is also an important test in identifying diseases where electrical transmission between nerves and muscles is impaired, such as myasthenia gravis.

Imaging methods such as MRI and CT

Magnetic resonance imaging (MRI) and computed tomography (CT) are imaging methods used to reveal structural changes in the central nervous system. These techniques clearly show the presence of damage or lesions in the brain and spinal cord.

MRI shows prominent pathologies in most spastic diplegia cases. Findings compatible with periventricular leukomalacia (PVL) are frequently seen, especially in preterm infants. However, abnormalities may not be seen on MRI in all spasticity cases.

Making a diagnosis in the early period ensures that patients achieve better results in the treatment process. Thus, a meaningful improvement in quality of life is aimed. Accurate and timely diagnosis is of critical importance in preventing the progression of spasticity and avoiding complications.

How is spasticity treated?

Spasticity treatment requires a special approach that varies from patient to patient. For effective treatment, a personalized program must be prepared by considering the severity, distribution, and underlying causes of spasticity. Treatment is usually carried out with a multidisciplinary approach encompassing physical therapy, drug therapy, and surgical interventions when necessary.

Physical therapy and rehabilitation

Physical therapy is the cornerstone of spasticity treatment. It includes a series of applications designed to reduce muscle tone, preserve and improve mobility. Stretching exercises performed at least twice a day reduce muscle stiffness and lengthen the muscle. Additionally, strengthening exercises improve functional status. Heat or cold treatments applied before stretching can increase effectiveness. In particular, the effect of ice treatment lasts for about 2 hours and applying it before exercise is beneficial.

Drug therapy and muscle relaxants

The muscle relaxants most commonly used in drug therapy include baclofen, tizanidine, diazepam, and dantrolen. These drugs work by inhibiting excitatory neurotransmitters in the brain and spinal cord or increasing inhibitory neurotransmitters. However, they may have side effects such as drowsiness, dizziness, and elevated liver enzymes. Therefore, it is important that medications are used regularly under doctor supervision and monitored with blood tests at regular intervals.

Botulinum toxin (botox) applications

Botulinum toxin is an effective treatment method that reduces excessive muscle activity when injected in small amounts into spastic muscles. The toxin temporarily stops contractions by preventing the release of acetylcholine at nerve endings. Its effect begins 24-72 hours after injection, reaches a maximum level within 3-4 weeks, and lasts an average of 3-4 months. Botulinum toxin treatment, when applied together with physical therapy, is an effective and safe option in improving the functional capacity of the patient.

Baclofen pump and surgical options

In cases of widespread and severe spasticity, a baclofen pump can be used. With this method, baclofen medication is given directly into the cerebrospinal fluid, becoming effective at much lower doses and reducing systemic side effects. The pump is placed subcutaneously on the side of the abdominal region, and the catheter is connected to the cerebrospinal fluid. The externally programmable pump contains enough medication to last an average of 6 months and can be easily refilled when it needs to be filled.

In severe cases that do not respond to other treatments, surgical interventions such as selective dorsal rhizotomy can be considered. In this procedure, muscle tone is attempted to be reduced by cutting certain nerve roots in the spinal cord.

Psychological support and social participation

Psychological support and social participation also hold an important place in spasticity treatment. Providing emotional support for patients and their relatives increases compliance with treatment. Especially in children, cognitive ability, social and emotional development play an effective role in the progression of treatment. Therefore, it is important for the treatment team to set realistic goals with the patient and their relatives and to openly discuss expectations.

7 Frequently Asked Questions

Let us answer the most frequently asked questions about spasticity in light of expert opinions. In this section, we will clearly and plainly answer common questions that come to the minds of both patients and their relatives.

Whether spasticity is temporary or permanent depends on the underlying cause and the person's general health status. While it can be temporary in some cases, it can remain constant or lessen in others. For example, according to the American Stroke Association, spasticity is seen in 25-43% of stroke patients within the first year. When correct treatment is applied, the severity of spasticity can be reduced and the patient can continue their daily life with fewer contractions. Thus, the person can become able to feed themselves and put on their clothes.

Botulinum toxin treatment is a method that prevents the release of acetylcholine by being injected into spastic muscles and temporarily stops muscle contractions. The procedure is usually performed on an outpatient basis in a short time. Before the injection, a pain-relieving cream is applied to the area, and the designated muscle is entered with the help of a thin needle. The administered dose is calculated based on the patient's weight and the size of the muscle. The effect usually begins within 3-7 days and reaches a maximum level at the 4th week. In small muscle groups, the effect begins to be seen within 24 hours, and in large muscles within 3-4 days. The effect of botox lasts an average of 3-4 months, but with an intensive physical therapy program, this period can be extended up to 6-12 months.

Yes, spasticity can be progressive. Spasticity that starts in any muscle group can spread to other muscle groups over time. The speed and degree of progression vary depending on the disease causing spasticity. For example, in progressive neurological diseases such as ALS, spasticity generally worsens over time. On the other hand, in congenital conditions such as cerebral palsy, not much progression may be seen. With an appropriate treatment and rehabilitation program, the progression of spasticity can be slowed down or brought under control.

It is possible to strengthen spastic muscles, but this must be done under the supervision of a physiotherapist. Physical therapy applications, regular exercises, and orthoses supporting correct posture help strengthen muscles. Strengthening exercises improve functional status by working the muscle against a certain resistance. However, these exercises are not applied to patients who have recently undergone surgery, have severe osteoporosis, or have restricted joint range of motion. In particular, combining stretching, strength, and resistance training is recommended.

Spasticity can cause pain. Post-stroke spasticity can lead to loss of movement and associated pain in particular. Muscles remaining contracted for a long time, muscle fatigue, and spasms can create pain. In addition, long-term contractions can lead to stiffness and calcification in the joints, causing additional pain. These pains can lead to both physical and psychological discomforts.

Exercise is recommended in terms of providing relief to spasticity patients. However, studies show that exercises do not have a direct effect on the treatment of the disease. Nevertheless, regular exercises help manage long-term symptoms of spasticity such as muscle pain, stiffness, or contracture. Water exercises are particularly effective; studies show that swimming increases muscle elasticity.

Spasticity patients experience physiological, psychological, and social difficulties. Muscle contractions can make daily activities such as dressing, eating, and personal care difficult. For example, spasticity in the legs makes walking difficult, while contractions in the arm and hand can lead to complete dependence in daily life. In addition, deformities in the body can also cause psychological problems such as anxiety, depression, and self-esteem issues. Contractions in the feet can lead to impaired balance, risk of falling, and calluses.

Are you experiencing symptoms of spasticity?

If muscle stiffness, involuntary contractions, or movement limitations affect your daily life, early evaluation is of great importance.

At Hisar Hospital Neurology Department, spasticity diagnosis and treatment are planned with advanced imaging methods, EMG tests, and a multidisciplinary rehabilitation approach.

You can learn about treatment options tailored to you by making an appointment with our specialist physicians.

Contact us for detailed information and appointments.