Muscle spasticity: definition, can it disappear?

Definition: what is spasticity?

“Spasticity is a movement disorder characterized by involuntary muscle contractions. This phenomenon affects the muscles of the limbs and/or neck and results in a stiffness“, summarizes Dr. Laura Terrier, Neurosurgeon. When the passive mobilization of a limb is carried out by the examiner, the muscular resistance increases and the latter returns to its original position when the mobilization is stopped. It is found in particular in certain pathologies such as in advanced forms of multiple sclerosis or as part of sequelae of stroke (stroke).

What causes spasticity?

“Spasticity isneuromuscular origineither because of a nerve problem affecting motor neurons muscles under voluntary control, or else a problem of transmission of information between the nerve and the muscle (nerve conduction)”, continues the specialist. You should know that our muscles are not completely relaxed at rest. “Indeed, there persists a muscular tension called the tone. This is regulated by the stretch reflex (osteotendinous reflex) which corresponds to the contraction of a muscle in response to its stretching. This is the reflex obtained by the doctor by hitting the patient’s knee with a hammer“. Spasticity occurs in case of lesion of the pyramidal system in the following pathologies:

• cerebrovascular accidents (stroke)
• multiple sclerosis (in evolved forms)
• brain and spinal cord injuries (of the spinal cord): trauma, tumour, infection
• cerebral palsy.

Can spasticity go away?

Spasticity cannot be cured, but its symptoms can be treated. “The prevention of spasticity is very important in order to avoid functional repercussions and on the quality of life of patients.“, concludes the neurosurgeon.

What are the symptoms of spasticity?

“The main symptoms of spasticity are muscle hypertonia and exacerbation of osteotendinous reflexes“, completes our interlocutor. These symptoms can have the following consequences:

• involuntary movements such as spasms
• a contraction
• a abnormal posture
• bone and joint deformities
• pains
• stiffness

“Spasticity has a functional impact and on the quality of life. It affects motor actions such as walking but also the loss of dexterity in the fingers and thus the performance of daily tasks such as wash and dress. The impact is also psychological with, in particular, loss of self-esteem“.

The diagnosis of spasticity is above all clinical. “The degree of muscular resistance to stretching confirms the diagnosis, answers the neurosurgeon. We’re talking aboutelastic hypertoniathat is to say that the spasticity increases when the examiner moves a limb, and this one resumes its initial position as soon as it is released, like a spring”. The purpose of the patient’s examination is to confirm the presence of spasticity and to look for motor difficulties, the degree of stiffness and the functional impact. “This assessment is essential to then define the objectives of the treatment”. In addition to the clinical examination, other tools are sometimes used such as recording of muscle activity by external electrodes (electromyography). “There are scales, like that ofAshworthmaking it possible to assess the severity of spasticity and the response to treatment.t”.

What is the treatment for spasticity?

“The management and follow-up of spasticity is multidisciplinary and personalized to the patient with a rehabilitative but also educational and participatory approach.acknowledges Dr. Terrier. The program is established after evaluation of the spasticity and its consequences and depends on the objectives set with the patient. It rests on medicinal and non-medicinal means“. The goal is to improve the quality of life by relieving symptoms and improving the active functions of the patient. “There re-education (physiotherapy and occupational therapy) is the basis of the treatment of spasticity”. The different treatments are:

• Installation of equipment (compression splints)
• Medication (Baclofen, Dantrolene)
• I’botulinum toxin injection in the muscle to relax it
• Injection into a motor nerve to destroy it (chemodenervation) with a local anesthetic, muscle relaxant or alcohol (alcoholization)
• There surgery

“There are also different neurosurgical and neuro-orthopedic techniques in the treatment of spasticity, such as:

• Administration into the spine (intrathecal) of a muscle relaxant via an implanted pump
• Muscle denervation (neurotomy)
• Cutting the tendons (tenotomies)
• The section of the nerve roots in the spinal cord (rhizotomy)”.

Thanks to Dr Laura Terrier, Neurosurgeon at the University Hospital of Rouen.