What are the statistics on spasticity?

From the Guidelines

Spasticity affects approximately 35% of stroke survivors, and if left untreated, it can lead to contracture, activity limitations, and participation restrictions. According to the study by 1, spasticity should be treated if it causes pain or affects mobility, activities of daily living (ADLs), or sleep. The treatment of spasticity involves a combination of physical and pharmacological modalities, including range-of-motion exercises, heat, cold, and electric stimulation, and splinting. Oral medications for spasticity of cerebral origin include dantrolene and tizanidine, and phenol or botulinum toxin injections may be used to target specific muscles or muscle groups.

Some key points to consider in the management of spasticity include:

• The use of botulinum toxin for patients with focal spasticity that is painful, impairs function, reduces the ability to participate in rehabilitation, or compromises proper positioning or skin care, as recommended by 1 and 1.
• The suggestion to offer intrathecal baclofen treatments for patients with severe chronic lower extremity spasticity that cannot be effectively managed by other interventions, as recommended by 1 and 1.
• The lack of sufficient evidence to recommend for or against the use of acupuncture or dry needling for spasticity management, as noted by 1 and 1.

In terms of specific treatment options, botulinum toxin is recommended for patients with focal spasticity that is painful, impairs function, or compromises proper positioning or skin care. Additionally, intrathecal baclofen may be considered for patients with severe chronic lower extremity spasticity that cannot be effectively managed by other interventions. It is essential to consider patient characteristics and preferences when selecting a treatment option, as noted by 1 and 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.

In one study, patients with multiple sclerosis were randomized to receive single oral doses of drug or placebo

A statistically significant reduction of the Ashworth score for tizanidine compared to placebo was detected at 1,2 and 3 hours after treatment.

In a multiple dose study, 118 patients with spasticity secondary to spinal cord injury were randomized to either placebo or tizanidine

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

Spasticity Statistics:

• Reduction in Ashworth score: Statistically significant reduction at 1,2, and 3 hours after treatment with tizanidine compared to placebo.
• Muscle tone reduction: Statistically significant reduction in muscle tone in tizanidine-treated group compared to placebo in multiple dose study.
• Spasm frequency reduction: Statistically significant reduction in frequency of spasms in tizanidine-treated group compared to placebo in multiple dose study.

2

From the Research

Spasticity Statistics

• Spasticity is a common and disabling symptom for many patients with upper motor neuron dysfunction 3
• It results from interruption of inhibitory descending spinal motor pathways, and although the pathophysiology of spasticity is poorly understood, the final common pathway is overactivity of the alpha motor neuron 3
• The impact of spasticity varies from it being a subtle neurological sign to severe spasticity causing pain and contractures 4

Treatment Options

• Therapy for spasticity is symptomatic with the aim of increasing functional capacity and relieving discomfort 3
• Treatment options include physical therapy, pharmacotherapy, and possibly surgery 3, 5
• Pharmacotherapy is generally initiated at low dosages and then gradually increased in an attempt to avoid adverse effects 3
• Optimal therapy is the lowest effective dosage 3
• Baclofen, diazepam, tizanidine, and dantrolene are currently approved for use in patients with spasticity 3, 6
• Botulinum toxin has shown efficacy in treating spasticity, especially in patients with focal spasticity 6, 5, 7

Management

• Treatment of spasticity requires a team approach, including the patient and caregivers, therapists, physicians, and surgeons 5
• The team needs to determine what component of the spasticity interferes with function 5
• Continued communication from all members of the team can assure the best spasticity management plan for the individual patient 5
• Patients need to have realistic expectations about outcome 5