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What is it about ?
Spasticity is characterized by an increase in tension and stiffness in a muscle. It is impossible to control this tension or stiffness. In other words, it is something absolutely involuntary. Spasticity almost always suggests damage to nerve cells in the central nervous system. However, not all disorders of the central nervous system (brain and spinal cord) are characterized by spasticity.
The constant increase in tension in a muscle is the result of a disturbed reflex. We have different types of reflexes: extension reflex, patellar reflex, etc. It is the brain and spinal cord that regulate reflexes via sensors in muscles and tendons. It is precisely the brain that makes it possible for a reflex to be activated and stopped, so to speak. If something abnormal happens in the brain, a reflex may be constantly “activated”. This is how what is called spasticity is born.
Spasticity is rarely the only symptom of a central nervous system disorder. Other possible signs are generalized muscle weakness, extreme vividness of tendon reflexes (e.g. patellar reflex), urinary incontinence, etc. Muscle spasms (or muscle cramps) are also quite characteristic of the problem: a muscle contracts in a way that is as sudden as it is uncontrollable. They can be particularly painful. The most common neurological causes of spasticity are: cerebrovascular accidents (stroke), multiple sclerosis (MS), brain tumors and traumatic injury to the brain and spinal cord.
How to recognize it?
Muscle tone can be tested by passively moving the limb of the person being examined. For example, we take his arm and move him past a point of articulation (eg elbow). This makes it possible to feel the tension of a muscle at rest and to assess whether the muscle is showing spasticity; in other words if the resistance to movement (passive muscle extension) increases.
How is the diagnosis made?
The physical examination will allow the doctor to diagnose spasticity. He will thoroughly test the resting tone of different muscle groups and assess their spasticity by passively moving them. He will also pay attention to the phenomenon known as the knife stroke: at the beginning of the movement’s trajectory, we feel resistance to the movement, which then suddenly disappears.
Further examinations are not necessary to detect spasticity. However, the doctor will always check why a person is suffering from spasticity. Depending on his findings, he may order a brain scan, blood work, etc.
What can your doctor do?
If spasticity affects your daily life, your doctor may prescribe medications (baclofen, tizanidine, and dantrolene). Sometimes diazepam is used. These medications often have side effects: drowsiness, too low blood pressure (certainly associated with high blood pressure medications), drowsiness, dry mouth, and confusion. It is best not to stop the medication abruptly, as this can lead to withdrawal signs.
Other possible treatments:
- the beneficial effect of therapeutic cannabis in the treatment of spasticity is increasingly recognized;
- botox injections may alleviate symptoms of spasticity; but their effect is only temporary and it is necessary to repeat the treatment regularly;
- in severe cases, baclofen can be administered directly into the spinal cord via an automatic pump;
- a surgical intervention makes it possible to cut very precisely several nerve pathways. This operation weakens the reflex arc which is at the origin of the spasticity.
The (long-term) management of spasticity is provided by different types of caregivers. The physiotherapist’s contribution is invaluable in this regard. It can help you with regular stretching exercises and by making you do joint movements. It will also teach you to adopt certain more favorable postures.
What can you do ?
Stretch regularly, if possible. In case of bed rest, the skin must be well cared for to avoid bedsores (decubitus).
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