Spasticity Treatment in Delhi, India

Damage to the brain, spinal cord, or nerve pathways that regulate movement and stretch responses is the most common cause of spasticity. There are several causes of spasticity. Some of them are:

• Traumatic damage to the spinal cord
• Multiple Sclerosis (MS)
• Paralysis of the brain, often known as cerebral palsy
• Stroke
• Traumatic brain injury or a head wound
• Amyotrophic lateral sclerosis (ALS) (a kind of neurodegenerative illness) 
• Paralysis is caused by spasticity that runs in families
• Adrenoleukodystrophy (ALD)
• Phenylketonuria
• Krabbe's illness

Depending on the severity of the condition, spasticity may cause anything from a little increase in muscular stiffness or tightness to excruciating pain and involuntary muscle contractions. Frequently, people with spasticity also have joint pain or stiffness. The symptoms of spasticity are as follows:

• Muscle tightness, impairing mobility and making it harder to do certain activities.
• Painful, involuntary contractions of muscle tissue, called muscular spasms
• Conscious or unconscious crossing of the legs
• Disfigurement of muscles and joints
• Reduced longitudinal muscle development due to tiredness
• Reduced protein production in muscle cells

Several diagnostic tests may be conducted to detect spasticity. A few of them are:

Physical exam

In most cases, the clinical evaluation will begin with a thorough review of the patient's medical history and then continue with an evaluation of the patient's posture, movement control, muscle strength, coordination, endurance, and spasticity. 

Observing a muscle's resistance to passive lengthening while the muscle is relaxed is an integral part of determining spasticity. Compared to the resistance other muscles in the body display to passive stretching, a muscle that is spastic will have a higher level of resistance.

When attempting to diagnose spasticity, it is possible that the participation of a healthcare team composed of professionals from many disciplines would be necessary. A physical therapist, physician, neurologist, rehabilitation physician, orthopaedic surgeon, and occupational therapist might be included in this group of medical professionals.

It is also essential to have a conversation about particular signs and symptoms the patient is experiencing at the time, as well as the challenges that may have arisen while attempting to participate in day-to-day activities as a direct consequence of the symptoms. In addition, having this information available will be helpful when beginning therapy for the illness.

Other Diagnostic Tests

An electromyography may be performed in certain circumstances to ascertain specific nerve conduction velocities, which may then direct the diagnostic process. In addition, diagnostic imaging methods may be used to see alterations to the head, neck, and spine and uncover potential explanations for muscle complaints.

For instance, magnetic resonance imaging (MRI) may gather information regarding the type of causal injury to the central nervous system.

There are several treatment options available to treat spasticity. The following are examples of nonsurgical therapies for spasticity:

Physical Therapy

In physical therapy, the emphasis is often placed on mobility training, lower extremity stretching and strengthening exercises, and other similar activities (transfers, standing, and walking).

Occupational Therapy

An occupational therapist would often place a greater emphasis on upper extremity stretching, strengthening, and training to do day-to-day tasks such as grooming, bathing, and cooking. Occupational therapy is also known as "hands-on" treatment.

Speech Therapy

If a patient has spasticity that affects the muscles in the mouth, face, and throat, a speech therapist may assist with speaking, communicating, and swallowing if one suffers from this condition.

Casting or Bracing

The use of casts or braces on the afflicted areas of the body may assist in offering a prolonged stretch of spastic muscles, improving the range of motion and enabling function.

Assistive Equipment

There is a broad array of assistive devices available that may help a person with spasticity move about and carry out everyday duties in a manner that is both more effective and safer.

Medication

Oral drugs are often prescribed by medical professionals in conjunction with other treatment modalities. In most cases, they won't recommend medication until spasticity seriously impairs the ability to operate normally or sleep.

Botox

It is possible to get excellent results in treating spasticity by administering local phenol or botulinum toxin (Botox) into spastic muscles. These injections can lower tone in the muscles generating the most significant constriction or spasm.

The healthcare practitioner will inject botulinum toxin into precisely chosen spots in the muscle during botulinum toxin injections. These injections will cause spastic muscles to relax. This may increase comfort as well as placement and function. It usually takes seven to ten days for the benefits to become evident, and they typically persist for around three months. 

When spasticity in just a few muscle groups has to be eased, this treatment is often a consideration. It is possible to use it in conjunction with many other spasticity therapies.

Spasticity is often only considered severe enough to warrant medical professionals' recommendation of surgical therapies.

The following treatments fall under this category:

Intrathecal baclofen therapy

Also known as ITB therapy, it is a treatment that involves surgically implanting a pump in the abdomen. This pump can deliver a constant dose of the medication baclofen to the spinal fluid through a catheter that is connected to the pump. Intrathecal baclofen therapy is also known as ITB therapy. Compared to the oral administration of baclofen, this method carries a reduced risk of sleepiness and may result in a considerable improvement in both spasticity and pain.

Selective dorsal rhizotomy

Spasticity brought on by an imbalance in the electrical impulses sent to particular muscles may be treated by selective dorsal rhizotomy (SDR). The selective dorsal rhizotomy (SDR) procedure involves surgically severing chosen nerve roots to rebalance the electrical impulses transmitted to the spinal cord. This surgery is only performed by surgeons when there is significant spasticity affecting the legs of the patient. Reduced muscular stiffness may be achieved with the targeted removal of troublesome nerve roots while other functions are preserved. SDR is the treatment that medical professionals most often suggested for patients diagnosed with cerebral palsy.

Orthopedic surgery

It is a kind of surgery that treats the effects of spasticity on the body's muscles, bones, and connective tissue, such as deformities and contractures. This type of surgery is performed on patients who have spasticity. Procedures such as tendon lengthening and tendon transfer are only a few examples.

Reviewed by Dr. Puneet Agarwal, Senior Director - Stroke and Dementia, Neurosciences, Neurology, on 27-Jan-2023.