Spasticity

Spasticity with multiple sclerosis

Have you ever experienced difficulty bending your leg because it seems stuck in a straight position? Or felt your foot jump up and down when you are just sitting? Or perhaps felt your whole body tighten up for a minute like a stiff board when you get into bed at night? These are all examples of something called spasticity.

Spasticity describes many different types of involuntary muscle contractions. You may hear other words from your healthcare professional that describe the same thing, such as hypertonicity, tone, clonus, dystonia, or rigidity.

If this is something you have experienced, you already know how spasticity can interfere with your mobility, or how you move. Spasticity can make it more challenging to walk, get into a car, or even sit easily in a chair. Over time, spasticity can lead to a loss of range of motion in your joints – for example, you may feel that your ankle or hip is not as flexible as it used to be. When your body becomes stiff and does not move easily, pain can occur.

How to manage spasticity

It is important to realize that there are strategies for managing spasticity. If you know that spasticity is an issue for you, you should discuss management options with a medical professional. Here we share tools that can be beneficial when working with spasticity.

In order to manage your spasticity, you will need to examine how it works in your body.

  • Is your spasticity worse in the morning?
  • Does it get worse when you are anxious?
  • Do you become more spastic when you are rushing?

The answers to these questions will give you clues to possible solutions.

Sometimes spasticity requires medical management. Your healthcare professional can talk with you about these options.

  • Oral medications such as Baclofen, Zanaflex, Dantrium, Valium, Clonazepam, or Gabapentin
  • Intrathecal Baclofen pump
  • Botox
  • Tendon release surgery for a muscle that has become fixed in a contracture

A physical therapist (PT) can help you to customize a stretching and strengthening program tailored to meet your particular needs.

They can also recommend braces and assistive devices and teach you how to move your body with greater ease and efficiency.

A PT will also have access to tools that have been shown to decrease spasticity, such as a vibration plate, electrical stimulation, or a standing frame.

Spasticity can get significantly worse with physical discomfort or pain from any source, such as an ingrown toenail, a UTI, constipation, tight shoes, and anxiety.

If you notice your spasticity is suddenly worse, consider whether there is an aggravating factor.

Sometimes simple solutions offer the greatest reward. The single best non-pharmacological solution to spasticity is consistent stretching. This will also help to maintain your joint range of motion, decrease stiffness, and minimize pain.

A closer look: The intrathecal Baclofen pump

An intrathecal (IT) pump sends medication from an implanted cylinder through a catheter to the intrathecal space surrounding the spinal cord.

This approach delivers Baclofen directly to the nervous system to allow for smaller doses, less side effects and better control of spasticity. The pump is surgically implanted under the skin of the lower abdomen or back near the waistline. A tiny catheter is routed from the pump to the intrathecal space of the spine.

The pump is roughly the size of a hockey puck with a reservoir to hold either 20 or 40 milliliters of liquid medication. The pump must be refilled with Baclofen every few weeks for up to six months. This is done by your provider inserting a needle into the filling port in the center of the pump to refill the tank with medication. With an external programmer, the provider sets the rate at which the pump will infuse the Baclofen.

When a medication is delivered directly to the nervous system:

  • A lower dose of medication is needed to manage your spasticity than if you took the medication by mouth.
  • There are fewer medication side effects. Sometimes oral baclofen can reduce your spasticity, but the side effects are too significant to continue taking the medication.
  • There is the option to add periodic boluses throughout the day to better treat your individual needs.
  • Successful spasticity management can improve an individual’s overall function, allow for greater independence and improve overall quality of life.

The surgical risks of intrathecal pump implantation are the same as with any spinal surgery.

The pump or catheter could malfunction, which could cause an overdose or withdrawal of the medication in the pump and lead to a life-threatening emergency.

The pump battery must be surgically replaced every 7.5 years.

You are an active participant in managing your spasticity with a Baclofen pump along with a team of healthcare providers. You will either see a physician or an advanced practice provider for all your pump visits.

Initially, you may have frequent visits to either adjust the pump settings or refill the pump until you and your provider find the best dose of Baclofen to manage your spasms.

Each pump refill visit is scheduled within days the pump is due for a refill. It is your responsibility to keep or reschedule your pump refill visit before the refill date. If an appointment is missed, you must reschedule as soon as possible because you are at risk of life-threatening withdrawal from baclofen.

Activity considerations

  • Before any medical or diagnostic procedure, it is important to inform your healthcare provider that you have an IT pump to determine if there are any safety considerations. IT pumps are compatible with MRI tests. The magnet in the MRI machine temporary stops the pump. Following each MRI, your pump must be interrogated to confirm the pump restarted with a pump analysis visit.
  • Alcohol and depressant medications may increase the sedating effects of your IT pump medication. Discuss with your provider if there are any limitations to alcohol consumption or changes to medications.
  • Hot tubs, steam rooms, saunas, and tanning beds with temperatures less than 102°F are safe to continue.
  • Flying on a commercial pressurized airplane and going through the metal detector in airport security will not interfere with the IT pump’s function. However, the metal detector may detect the pump, so be prepared to present your Medtronic identification card to the airport screener with any questions or concerns.
  • Common household appliances such as microwaves, telephones and power tools will not impede the pump’s operation.

Your provider will order a Baclofen pump trial in the Shepherd Spine and Pain Institute. This is a 20-minute procedure followed by 4-6 hours of observation and evaluation by a physical therapist to determine if the intrathecal Baclofen reduces your spasticity.

During your procedure follow-up visit, you and your provider will review the outcome of your trial. If you have a significant reduction in spasticity (successful response) during the trial, your provider will discuss whether you want to proceed with the pump implantation and then refer you to a neurosurgeon. If you do not have significant reduction in spasticity (unsuccessful response) during the trial period, your provider will talk about other treatment options.

The first visit with the neurosurgeon is considered both a consult and a pre-operative visit. The neurosurgeon’s office will coordinate with you and the hospital to set a date for surgery.

One week following your pump implantation, you will return to Shepherd Center for your first Baclofen pump analysis visit.

For more information, visit Medtronic or the Christopher and Dana Reeve Foundation.

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