Spasticity Treatment Options

Inappropriate expectations about the effectiveness of treatment may lead to disappointment regarding relief of symptoms and pain. Therefore, ongoing communication and agreement by the patient, caregivers, and healthcare professionals regarding the goals of treatment are extremely important.

Physical Therapy
Although physical therapy is a mainstay of treatment for spasticity, there has been surprisingly little research conducted to support the use of these techniques. Physical therapy for spasticity refers to a range of physical (as opposed to drug or surgical) treatments. These treatments of spastic muscles are designed to reduce muscle tone, maintain or improve range of motion and mobility, increase strength and coordination, and improve care and comfort. The choice of treatments is individualized to meet the needs of the person with spasticity. Physical therapy is the most common form of treatment for spasticity in children.

Oral Medications
The use of oral medication to treat spasticity is indicated when stiffness, spasms, or clonus interfere with daily functioning or with sleep. Effective spasticity management may require the use of two or more drugs or a combination of oral medications with another type of treatment such as chemodenervation or ITB Therapy. Common medications include:
Baclofen: Baclofen acts on the central nervous system to relax muscles. It also decreases stretch reflexes, the rate of muscle spasms and clonus, pain, and tightness and improves range of motion.
Benzodiazepines: Like baclofen, benzodiazepines are a group of drugs that act on the central nervous system to relax muscles, temporarily decreasing spasticity. Because of their sedative effects, benzodiazepines are given most often at night.
Dantrolene sodium: Dantrolene acts directly on the muscle by blocking the signals that cause muscles to contract.
Imidazolines: These drugs typically cause less muscle weakness than baclofen and benzodiazepines. This factor may be valuable when it is important for the patient to retain strength.
Gabapentin:Gabapentin is a drug that is typically used in the treatment of seizures and is also used in the treatment of spasticity caused by MS and spinal cord injury. This medication has minimal effects on concentration or thinking, but sedation may be a problem.

ITB Therapy
Baclofen can be delivered directly into the thecal space with a programmable pump. This delivery method is called ITB Therapy, and it is used to treat severe spasticity caused by brain or spinal cord damage. It is especially useful for treating spasticity in people with cerebral palsy and is most effective for spasticity of the lower limbs.

Chemodenervation interrupts neuronal signaling and is achieved with the use of BTX or neurolysis, which destroys nerve tissue. It is typically used to treat spasticity of focal origin and is often used in combination with other therapies. The agent is injected directly into the muscle (motor point block) or nerve (nerve block), preferably as close as possible to the motor end plates

Surgical Treatments
In many cases, a combination of neurosurgical and orthopedic operations may be undertaken. While each surgical approach has certain strengths and weaknesses, none completely eliminate spasticity or its effects. Surgery should not be seen as a last resort when other treatments have failed. Instead, surgery may be considered when a permanent reduction is needed in muscle tone or when muscle force needs to be redirected.

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