From the Guidelines
Spasticity affects approximately 12 million people worldwide, with prevalence rates varying by underlying condition, and the most effective treatment approach often involves a multidisciplinary strategy combining pharmacological interventions with physical therapy, as supported by recent guidelines 1.
Spasticity Prevalence and Treatment
Spasticity is a common complication in various neurological conditions, including multiple sclerosis, stroke, cerebral palsy, spinal cord injury, and traumatic brain injury. The prevalence of spasticity in these conditions can vary significantly:
- Multiple sclerosis: approximately 80% of patients experience spasticity
- Stroke survivors: 30-80% develop spasticity
- Cerebral palsy: 70-80% of cases, primarily in the spastic diplegic and quadriplegic forms
- Spinal cord injury: 65-78% of patients develop spasticity, typically within the first year after injury
- Traumatic brain injury: 25-43% of cases
Treatment Approaches
Treatment for spasticity often begins with oral medications such as:
- Baclofen (starting at 5mg three times daily, gradually increasing to 20-25mg three times daily as needed)
- Tizanidine (2-4mg initially, up to 36mg daily in divided doses)
- Dantrolene (25mg daily, increasing to 100mg 2-4 times daily)
For focal spasticity, botulinum toxin injections (Botox 100-400 units per session) are effective, as recommended by recent guidelines 1. Severe generalized spasticity may require intrathecal baclofen therapy (starting with a test dose of 50-100mcg, followed by pump implantation if successful).
Multidisciplinary Approach
Management of spasticity typically requires a multidisciplinary approach combining pharmacological interventions with physical therapy to maximize functional outcomes. This approach should be tailored to the individual patient's needs and characteristics, as suggested by recent studies 1.
From the FDA Drug Label
Tizanidine’s capacity to reduce increased muscle tone associated with spasticity was demonstrated in two adequate and well controlled studies in patients with multiple sclerosis or spinal cord injury. A statistically significant reduction of the Ashworth score for tizanidine compared to placebo was detected at 1,2 and 3 hours after treatment. At endpoint (the protocol-specified time of outcome assessment), there was a statistically significant reduction in muscle tone and frequency of spasms in the tizanidine treated group compared to placebo
The statistic related to spasticity is that tizanidine showed a statistically significant reduction in muscle tone associated with spasticity in two studies, with significant reductions in Ashworth score at 1,2, and 3 hours after treatment in one study, and a significant reduction in muscle tone and frequency of spasms at endpoint in the other study 2.
- Key points:
- Reduction in muscle tone: Statistically significant reduction in Ashworth score
- Time frame: 1,2, and 3 hours after treatment
- Study design: Two adequate and well-controlled studies
- Patient population: Patients with multiple sclerosis or spinal cord injury
From the Research
Spasticity Statistics
- Spasticity is a velocity-dependent increase in muscle tone and uncontrolled, repetitive, involuntary contractions of skeletal muscles, often presenting as upper motor neuron symptoms in patients with central nervous system pathology such as stroke, spinal cord injury, brain injury, or multiple sclerosis 3.
- The treatment of spasticity requires a team approach, including the patient and caregivers, therapists, physicians, and surgeons, to determine what component of the spasticity interferes with function 4.
- Traditional therapy continues to dominate the therapy provided to patients who are living with spasticity, and may include physical and occupational therapy, oral medication, injections of botulinum toxin, use of an intrathecal baclofen pump, or surgery 4.
Treatment Options
- Oral medications comprise centrally acting agents, such as baclofen, clonidine, and tizanidine, as well as anticonvulsants such as benzodiazepines and gabapentin and peripherally acting dantrolene 3.
- Interventional procedures include focal injections of botulinum toxin, phenol or alcohol, and an intrathecal baclofen pump, with botulinum toxin being the preferred treatment for focal spasticity 3, 5.
- Surgical treatments include selective dorsal rhizotomy and neurectomy, reserved for patients in whom other modalities fail to provide meaningful improvement 3, 4.
Rehabilitation Procedures
- Non-pharmacological procedures for treating spasticity have been put forward, including muscle stretching, muscle reinforcement, physical agents and pain management, which may have both neurophysiological and biomechanical effects on the spastic movement disorder 6.
- Rehabilitation interventions can be integrated with traditional pharmacological procedures in the management of the spastic movement disorder, with existing evidence supporting their potential role as a therapeutic tool 6.