Spasticity is a condition in which the muscles are hyperactive. Spasticity, also known as spastic paralysis is an abnormal increase in muscle tone and stiffness.It occurs typically as a result of insult to the nerve pathway controlling the movement of muscle
Causes of spasticity
Sudden onset of spasticity may be caused by any of the following
When the spinal cord is attached to its column making the cord to be trapped or stuck in between the spinal column
Tumor of the spinal cord which can either be primary or metastasized tumor
Bleeding into the brain
Hydrocephalus (accumulation of fluid in the brain cavity)
An ongoing spastic analysis can be worsened by conditions like urinary tract infection, seizure bladder detention or bowel impaction which are basically factor that can further stretch the affected muscles. Spasticity can also be caused by stroke, head trauma, and spinal cord injury.
==> Read More: Spinal Cord Injury
Signs and symptoms
On examination, the muscle shows resistant to changes in movement. The signs and symptoms include
muscle spasm and tightness
Rigid and stiff joint
Involuntary and continuous movement
Hyper reflexia which means the exaggerated response of the reflexes
Spasticity is demonstrated by over 80% of patients living with cerebral palsy. Due to the hypoxic insults to the brain, shortly after birth; the brain is damaged.
Cerebral palsy affects the region of the brain that controls the movement of the muscle of the arms and legs. Children with cerebral palsy exhibit specific muscle patterns which can be diplegic (paralysis affecting the opposite sides of the body), quadriplegic (the paralysis affects both arm and legs) or paraplegic or hemiplegic (has a side of the body paralyzed e.g right side affecting both right arm and leg).
Spasticity is usually diagnosed by a thorough history and examination. Electromyography may be useful for the evaluation and ruling out of motor neuron disease.
During the history, you will be asked about the incidence of the same condition in your family members, this is important because spasticity can sometimes run in family.
The examination will also be very thorough with an emphasis on muscular, skeletal and neurological examinations. Laboratory studies like complete blood count, cerebrospinal fluid aspiration for cytology and urine for culture may help rule out infection.
Your doctor might also request your blood electrolyte, urea, and creatinine level.
Prevention is the most effective treatment measures. Majority of cases of spastic paralysis are caused by cerebral palsy which is majorly caused by birth asphyxia -a preventable cause of neurological sequelae in newborn.
The incidence of birth asphyxia can be prevented by ensuring delivery in a well-equipped delivery center.
Spasticity can also be combatted with the use of seizure combatting drugs like diazepam and clonazepam. This medication relaxes the muscle which then stops the involuntary jerking movements of the muscles, thereby preventing further muscular injury. Anti-seizure medications can also be used to reduce the incessant contractions.
Effective drug management may require the use of two or more drugs or a combination of oral medications with another type of treatment. Aside benzodiazepines like diazepam and clonazepam, other available medications are baclofen, dantrolene sodium, Imidazolines and gabapentin
The patient should also be referred to a physiotherapist who will carry out muscle stretching test and range of motion exercise.
The physiotherapist can also be of assistance to a child with cerebral palsy; there are different modifications used by them to prevent the progression of loss of muscle function.
In a patient with chronic spasticity, surgical intervention involving a neurosurgeon and an orthopedic surgeon may be undertaken to allow normal muscle and bone growth. The primary neurosurgical procedures used in treating spasticity are intrathecal baclofen pumps and selective dorsal rhizotomy. Also, Botulinum toxin injection when used in small amounts has been proved to be effective in paralyzing spastic muscles. Injection sites are carefully determined based on the pattern of spasticity.
The outcome of spastic paralysis is largely dependent on the severity of the conditionand associated comorbidities. Apatient who has spasticity co-existing with cerebral palsy or multiple sclerosis will have a poorer prognosis compared to the one with isolated spasticity.