What are the symptoms and signs of spastic paralysis?

From the Guidelines

Spastic paralysis is characterized by increased muscle tone, stiffness, and involuntary muscle contractions, with symptoms including hypertonia, hyperreflexia, clonus, and the Babinski sign, and is best managed with a multidisciplinary approach including physical therapy, muscle relaxants, and botulinum toxin injections, as supported by the most recent evidence from 2025 1. The main symptoms of spastic paralysis include:

• Hypertonia (abnormally high muscle tone)
• Hyperreflexia (overactive reflexes)
• Clonus (rhythmic muscle contractions)
• The Babinski sign (upward movement of the big toe when the sole is stimulated) Patients typically experience muscle weakness, impaired voluntary movement, and abnormal posture with limbs often held in flexed positions. Spasticity may cause pain, muscle spasms, and contractures over time. Daily activities become difficult as movements are jerky and uncoordinated. Speech may be affected if facial or oral muscles are involved. The condition results from damage to the upper motor neurons in the brain or spinal cord, disrupting normal inhibitory signals and causing excessive muscle activation. This condition commonly occurs in disorders like cerebral palsy, multiple sclerosis, stroke, traumatic brain injury, and spinal cord injuries. Management typically involves:
• Physical therapy
• Muscle relaxants like baclofen or tizanidine
• Botulinum toxin injections
• In severe cases, surgical interventions to release contracted muscles or tendons, with evidence supporting the use of botulinum toxin for patients with focal spasticity depending on patient characteristics and preferences 1. It is essential to note that the cost of care for patients with spasticity is significantly higher than for those without spasticity, and the independent impact of spasticity on costs is not well understood 1. Early treatment is crucial to preventing disabling complications, and a stepwise approach to managing spasticity, beginning with noninvasive and progressing to more invasive modalities, is recommended 1.

From the FDA Drug Label

Baclofen tablets are useful for the alleviation of signs and symptoms of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity. 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. Response was assessed by physical examination; muscle tone was rated on a 5 point scale (Ashworth score), with a score of 0 used to describe normal muscle tone A score of 1 indicated a slight spastic catch while a score of 2 indicated more marked muscle resistance.

The symptoms and signs of spastic paralysis include:

• Flexor spasms
• Concomitant pain
• Clonus
• Muscular rigidity
• Increased muscle tone, which can be measured by the Ashworth scale, with scores ranging from 0 (normal muscle tone) to 4 (muscle immobilized by spasticity) 2 3.

From the Research

Symptoms and Signs of Spastic Paralysis

The symptoms and signs of spastic paralysis can be understood through the following key points:

• Spasticity is a common and disabling symptom for many patients with upper motor neuron dysfunction, resulting from interruption of inhibitory descending spinal motor pathways 4.
• It is characterized by a velocity-dependent increase in muscle tone and uncontrolled, repetitive, involuntary contractions of skeletal muscles 5.
• Patients with spasticity can experience significant pain and limited mobility, leading to decreased quality of life and difficulty maintaining personal care 5.
• Spasticity presents as upper motor neuron symptoms in patients with central nervous system pathology such as stroke, spinal cord injury, brain injury, or multiple sclerosis 5.

Treatment and Management

Treatment options for spasticity include:

• Oral medications such as baclofen, clonidine, tizanidine, and dantrolene 4, 5.
• Interventional procedures like focal injections of botulinum toxin, phenol or alcohol, and intrathecal baclofen pump 5.
• Surgical treatments including selective dorsal rhizotomy and neurectomy 5.
• Physical therapy, occupational therapy, orthotics, and orthopedic surgery also play important roles in the management of spasticity 6, 7.

Specific Considerations

• Botulinum toxin A has been shown to be an effective treatment for focal spasticity, particularly in children with cerebral palsy 6, 7.
• Intrathecal baclofen can provide relief for patients with refractory severe spasticity 4, 8.
• A multidisciplinary approach to treatment, including physical therapy and possibly surgery, is recommended 4.