If you’re living with multiple sclerosis (MS), cerebral palsy or another neurological condition, you may already be well familiar with the idea (and effects) of spasticity. That’s the term for muscles that are stiff or that move involuntarily as a result of nervous system damage. For example, people experiencing spasticity may clench their fists, point their toes or cock their head to one side without being in control of those movements.
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Spasticity is common in conditions that affect the brain or spinal cord, including:
We talked with rehabilitation specialist Francois Bethoux, MD, about treating spasticity in adults living with MS, cerebral palsy, stroke and other neurological conditions. Your options may surprise you.
Spasticity doesn’t always need to be treated, but when it causes adverse effects such as pain, discomfort, or difficulty moving or performing daily activities, a range of options are available.
If you’re experiencing spasticity, your first lines of defense are usually stretching, exercise and rehabilitation. Your doctor may also prescribe certain medications such as baclofen, tizanidine or dantrolene.
For people with spasticity that affects only a few muscles, botulinum toxin (or Botox®, the commonly known name brand) has been clinically proven to be helpful.
“Botulinum toxin has been shown to be a low-risk, high-reward treatment option for people living with spasticity,” says Dr. Bethoux. “It effectively relaxes spastic muscles by temporarily changing the communication between nerves and muscles.”
Your doctor may recommend intrathecal baclofen (ITB) or other therapies if your spasticity is more severe and widespread.
Botox is probably best known for its cosmetic uses — it’s a favorite among celebrities looking to keep their faces young and smooth. More than a “magical” eraser for your laugh lines, though, it’s proven to be a powerful tool for those living with spasticity.
Botulinum toxin is a medication derived from a neurotoxin produced by the bacteria Clostridium botulinum. In its natural form, botulinum toxin causes botulism, but the medication form is formulated to not cause botulism. There are three formulations of botulinum toxin A that are approved by the Food and Drug Administration (FDA) for treating spasticity:
In healthy individuals, your brain sends messages to your nerves. Those nerves then release a substance called acetylcholine, which then relays those messages to your muscles. Your muscles contract and move as instructed by your brain.
For people with spasticity, damage to their nerves floods their muscles with messages. Basically, your nerves send out messages telling your muscles to spasm and tense up when your muscles should be allowed to relax.
“What botulinum toxin does is block the release of acetylcholine from the nerve to the muscle, which causes the muscle to relax,” Dr. Bethoux explains. “For patients living with spasticity, relaxing the muscles means less stiffness in the muscles and improved range of motion.”
Your doctor may recommend Botox if your spasticity is limited to only a few muscle groups — your arms or legs, for example. Botox is also helpful when many muscles are spastic, but only a few spastic muscles are causing issues.
Botox can be used in addition to other treatments for spasticity.
Botox is given as an intramuscular injection (a shot that goes into your muscle). The injections are given during an outpatient visit, which will probably last about 30 minutes to 45 minutes.
Because Botox doesn’t travel far from the injection site, your doctor will likely perform several injections during your visit. To ensure the medication is injected in the right place, electrical signals are recorded from your muscle or sent through the needle into your muscle during the injection. Sometimes, ultrasound is used to directly visualize your muscle and the needle.
“After an injection, you may not notice any difference for a few days, even up to two weeks. That’s perfectly normal,” notes Dr. Bethoux. “Once the effects take hold, you should see improvements that last for about two to three months.”
Treatments are generally repeated every three months. In many cases, physical or occupational therapy may be recommended after the injections to maximize the benefits. You’ll also be advised to stretch and exercise daily at home.
