Spasticity

Spasticity is a common symptom of multiple sclerosis (MS). This term refers to stiffness and muscle spasms resulting from problems with the nerves that control movement. Spasticity is often mild or moderate, but it can cause severe pain and make normal activities harder. Spasticity is most common in the legs.^1,2

Mild spasticity may not need treatment. Some spasticity may actually help provide support while standing or walking. For more serious spasticity, physical therapy and medicines may be necessary.^1,2

What does spasticity look like?

More than 60 percent of people with MS experience spasticity. That equals more than 900,000 people in the United States. About 1 in 5 people who have MS with spasticity report serious effects on their quality of life.³

Spasticity often feels like mild muscle tightness. It is most common in the calf, thigh, groin, and buttocks. Some spasticity can be helpful for some people with MS because stiffness can give the legs more rigidity. This can make it easier for people with leg weakness to stand, move, and walk.^1,2

However, spasticity can be severe and cause painful spasms. These spasms can be sudden and intense. Spasticity also can cause pain around joints and the lower back. The 2 types of spasticity are:¹

• Flexor spasticity – Muscles are so tight that bent limbs are hard to straighten
• Extensor spasticity – Muscles are so tight that straight limbs are hard to bend

For many people with MS, spasticity worsens with sudden movements. Other potential triggers of spasticity include:^1,3

• Position changes
• Temperature extremes
• Humidity
• Infections
• Tight clothing
• Slight contact
• Stress
• Longer disease duration
• Relapses of MS symptoms

Spasticity can have a big impact on your quality of life and emotional health. It can interfere with relationships, employment, and other daily activities. Spasticity can also lead to anxiety, depression, and low self-esteem.²

Why does multiple sclerosis cause spasticity?

Spasticity in MS is caused by demyelination of and damage to nerves that regulate movement. Myelin is a protective coating around parts of nerve cells (neurons). It protects nerve cells and allows electrical signals to be transmitted.^2,4

Demyelination occurs when your immune system mistakenly attacks the myelin sheath. This affects how your nerves communicate. When nerves involved in movement are affected, MS can cause spasticity.⁴

How is spasticity treated?

While mild spasticity may not need treatment, moderate or severe spasticity may. The goal of treatment is to ensure comfort and prevent complications. Treatment can also reduce fatigue and improve coordination.^1,5

The right treatment depends on several individual factors, including:^1,2

• Other underlying conditions that increase the risk of spasticity
• Risk for serious complications
• Symptom frequency and severity
• Personal preference

Physical therapy is often the first approach to treating spasticity. Physical therapists can suggest stretching or exercise routines to help with mobility.^1,2,5

Also, most people with MS and spasticity take at least 1 drug for spasticity. Common drugs used to treat spasticity include:^1,2,5

• Lioresal^® (baclofen)
• Zanaflex^® (tizanidine)
• Klonopin^® (clonazepam)
• Valium^® (diazepam)
• Dantrium^® (dantrolene)
• Neurontin^® (gabapentin)
• Keppra^® (levetiracetam)
• Lyrica^® (pregabalin)
• Botox^®, Dysport^®, and Myobloc^® (botulinum toxin)

Baclofen is the most common drug prescribed to treat spasticity in MS. But it can cause side effects including weakness and fatigue. Your doctor will find a dose that relieves spasticity without causing weakness or significant fatigue. If this balance is not possible, your doctor may suggest an alternative spasticity drug or a baclofen pump. This surgically implanted pump delivers the medicine to the spinal canal, which reduces the dose needed for desired benefits.^2,5

Braces, assistive devices, and complementary and alternative medicines also may be treatment options. Talk to your doctor about the benefits and risks of each treatment.