Spasticity
Spasticity is a medical term for muscular stiffness or tightness. The nervous system works through inhibition: our muscles are naturally ready to move on cue from our brain. In MS, the brain-spinal cord connection is interrupted so the reflexes are dysinhibited. Muscles then tend to contract too much or too often. This causes spasticity.
The most effective treatment for spasticity is physical or occupational therapy. Exercises target the muscles and so we re-learn how to relax them. If physical exercise or therapy is not done regularly, the symptoms will return. Sometimes, in spite of the therapy, this symptom gets worse. In this instance, medications may help to relax the muscles.
The problem is the drugs cannot target just the stiff or spastic muscles: all muscles will relax and this may impact on strength, mobility or energy levels.
Baclofen is the most popular treatment and
Tizanidine is the newest.
Diazepam is also good though it is a sleeping pill that may put you to sleep by relaxing you - almost too much. It is useful when anxiety and sleeping problems also occur.
Dantrolene is not used often because it has side effects but it is another possibility.
A new option for selected cases may be Botox. In its natural state, the toxin used to create Botox can kill people, but if we take the right type of toxin, administer the right amount in the right location via a needle into the muscle, then we can “freeze” that muscle and halt spasticity. However, Botox is a toxin and results can be unpredictable. Also, it takes an enormous amount of the bacterium to produce enough Botox to freeze a small muscle in your face. It is usually the larger muscles, such as those in the legs, which are affected by spasticity in MS. The amount of toxin required, and therefore the cost, is quite prohibitive. And treatments must be repeated every few months. However, for people with selective spastic muscles, Botox may be a possible approach. Currently, Botox is being used via injection with children with cerebral palsy. Is any one doing research on people with MS using Botox in Canada? I don’t know of any formal research. Children have smaller muscles so it is easier and less expensive to use Botox. Also, the treatments are short-term, intended to give children an opportunity to learn how to use their muscles, so that they can apply this knowledge long term.
In MS, we are looking for long-term treatments for spasticity in much larger muscles.
Are there any over the counter drugs that help with spasticity? Does this include herbal therapies you can purchase at the over the counter?
Yes and no. Common over the counter drugs will treat pain and muscle contractions caused by over-exertion. Some include muscle relaxants. But these are different from the muscle relaxants mentioned earlier which impact neurologically. These are helpful in MS. Ibuprofen will help regular strained muscles but will not help with MS spasticity. Herbal therapies have not been formally researched as much but it is highly unlikely that they will have an effect on the central nervous system. I would not advise you to discontinue prescribed medication without your doctor’s supervision.
I started taking a drug for spasms that is actually used for seizures. Why was this recommended?
Many drugs are approved for a specific condition (i.e. seizures) and yet may be beneficial for people with another condition (i.e. MS). The drug you mention is likely
carbamazepine or gabapentin.
Some people have tonic spasms, little jerky movements, mostly in the legs that occur infrequently. People sometimes call these “charley-horses” and they can be painful. Because the individual does not require continuous, permanent medical treatment, but only when the tonic spasms occur, we have been experimenting with anti-epileptic medication. Carbamazepine or gabapentin can help and usually do for this specific type of tonic spasms.
From: The MS Society Ontario, Canada