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Spasticity

Spasticity is a condition in which there is an abnormal increase in muscle tone or stiffness of muscle, which might interfere with movement, speech, or be associated with discomfort or pain.

The degree of spasticity varies from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms. Left untreated, you child may develop more serious complications such as loss of muscle use, or deformity of the joints. Spasticity can interfere with rehabilitation in patients with certain disorders, and often interferes with daily activities, including walking or the use of fingers and hand, as well as loss of balance, among others.

What causes it?

Spasticity is usually caused by damage to nerve pathways within the brain or spinal cord that control muscle movement. There are numerous conditions that may result in spasticity issues. The following is a partial list that includes some of the more common ones:

  • Spinal cord injury
  • Multiple sclerosis
  • Cerebral palsy
  • Stroke
  • Brain or head trauma
  • Myotrophic lateral sclerosis
  • Hereditary spastic paraplegias
  • Metabolic diseases such as:
    • Adrenoleukodystrophy
    • Phenylketonuria
    • Krabbe disease

How is it diagnosed?

Because spasticity is typically related to other medical conditions, it's often diagnosed at the same time. In many instances, spasticity is one of the first signs that something is wrong. If your pediatrician feels suspects spasticity, your child will be referred to a neurologist for testing and diagnosis. Specialists at the Jane and John Justin Neurosciences Center at Cook Children's are some of the most recognized in U.S. and offer the latest diagnostic tools and treatments.

The Spasticity Clinic at Children's uses a family centered approach dedicated to reducing and controlling spasticity in children. Your child will be evaluated and managed by specialists in pediatric orthopedics, psychiatry, neurosurgery and physical therapy. The team works together to provide the best treatment plan possible for each child with spasticity.

During your initial appointment, the doctor will take a complete medical history, perform a thorough physical exam. He or she will also ask questions about the symptoms such as when you first noticed them, how long they last, are they constant or do they come and go, how sever are they, what makes them better or worse, what muscles seem to be involved? The doctor will also test certain reflexes, muscle strength and movement. Depending on the symptoms and any related conditions, brain scans, such as an MRI or CT scan may be requested, as well body scans, which may also include X-rays.

What are the symptoms?

The symptoms your child has are somewhat different, depending on the cause of their spasticity, but some of the more common symptoms you may notice include, but aren't limited to:

  • Abnormal posture
  • Hypertonicity, or increased muscle tone
  • Shoulder, arm, wrist, hand or fingers are at an odd angle because of muscle tightness
  • A series of rapid muscle contractions, known as clonus, that cause repetitive or jerky motions, especially in response to touch
  • Exaggerated deep tendon reflexes
  • Muscle spasms
  • Scissoring, or an involuntary crossing of the legs
  • Fixed joints or contractures

How is it treated?

How your child's spasticity is treated will depend on many things, especially the cause and the severity of the symptoms your child has. In most cases, your child will be referred to physical therapy. Certain types of exercise can help to stretch and strengthen your child's muscles.

The therapists will also work with you and your family members so you can help your child with the exercises at home.

Your child's treatment plan may include the following:

  • Daily stretching and other exercises to help to relieve spasticity
  • If drugs are also needed, there are two major antispasticity drugs that have good safety records. Neither, however, can cure spasticity or improve muscle coordination or strength.
    • Baclofen, the most commonly used drug, is a muscle relaxant that works on nerves in the spinal cord. Common side effects are drowsiness and a feeling of muscle weakness. It can be administered orally or by an implanted pump (intrathecal baclofen). Intrathecal baclofen is used for severe spasticity that cannot be managed with oral medication.
    • Tizanidine (Zanaflex®) works quickly to calm spasms and relax tightened muscles. Although it doesn't produce muscle weakness, it often causes sedation and a dry mouth. In some patients, it may lower blood pressure.
    • Other, less commonly-used drugs, include:
    • Diazepam (Valium®) –not a "first choice" drug for spasticity because it is sedating and has a potential to create dependence. However, its effects last longer with each dose than baclofen, and physicians may prescribe small doses of Valium® at bedtime to relieve spasms that interfere with sleep.
    • Phenol, a nerve block agent
    • Botulinum toxin (Botox®) injections–have been shown to be effective in relieving spasticity in individual muscles for up to three months
    • Clonidine–still considered experimental

Surgery may be recommended for tendon release or to sever the nerve-muscle pathway.

Whatever treatment your doctor prescribes for your child, it is very, very important to follow the plan. Left untreated, spasticity can cause very serious complications.

If you have any concerns about your child's treatment plan, or need help following, you will want to discuss these issues with your doctor. Knowing what your concerns are and what obstacles you may face in carrying out any parts of your child's treatment plan will help your doctor to create a plan that is comfortable for you and that works in the best interest of your child's health, as well.

At Cook Children's, we're in this together as a team, and that includes you and your child.

We're here to help.

If your child has been diagnosed, you probably have lots of questions. We can help. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-2500.