From the Guidelines
Preventing spasticity completely is not always possible, but there are several strategies that can help reduce its occurrence and severity, with the most recent and highest quality study suggesting that targeted injection of botulinum toxin into localized upper limb muscles is recommended to reduce spasticity, improve passive or active range of motion, and improve dressing, hygiene, and limb positioning 1.
Strategies for Prevention
To reduce the occurrence and severity of spasticity, several strategies can be employed:
- Early intervention is key, particularly for individuals with conditions that commonly cause spasticity such as stroke, multiple sclerosis, cerebral palsy, or spinal cord injuries.
- Regular physical therapy involving stretching exercises should be performed daily to maintain muscle length and prevent contractures.
- Range-of-motion exercises, both passive and active, help maintain joint flexibility.
- Proper positioning throughout the day and night using supportive devices can prevent muscle shortening.
Medications and Interventions
For those at high risk, medications may be prescribed preventatively, including:
- Baclofen (starting at 5mg three times daily, gradually increasing to 20-25mg three times daily as needed)
- Tizanidine (2-4mg initially, up to 8mg three times daily)
- Targeted injection of botulinum toxin into localized upper limb muscles is recommended to reduce spasticity, improve passive or active range of motion, and improve dressing, hygiene, and limb positioning 1.
Maintaining Overall Health
Maintaining good overall health through proper nutrition, hydration, and avoiding triggers like infections or pressure sores can also help prevent spasticity flare-ups.
Underlying Principle
The underlying principle is that preventing muscle shortening and maintaining flexibility helps avoid the neurological changes that lead to spasticity, as shortened muscles can trigger increased reflex responses that worsen the condition over time.
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.
The answer to whether it is possible to prevent spasticity is no, the provided information only discusses the treatment of spasticity with tizanidine, not prevention. 2
From the Research
Prevention of Spasticity
There are no direct research papers that provide evidence on the prevention of spasticity. However, several studies discuss the treatment and management of spasticity, which may imply that prevention is not currently possible.
Treatment and Management of Spasticity
- The treatment of spasticity is symptomatic, aiming to increase functional capacity and relieve discomfort 3.
- A multidisciplinary approach, including physical therapy, surgery, and pharmacotherapy, is recommended for the treatment of spasticity 3, 4, 5.
- Various medications, such as baclofen, diazepam, tizanidine, and dantrolene, are approved for the treatment of spasticity 3, 4, 6.
- Botulinum toxin has shown efficacy in treating focal spasticity, but more studies are needed to confirm its place in therapy 3, 4, 5.
- Intrathecal baclofen may provide relief for patients with refractory severe spasticity 3, 5.