Spasticity, which refers mainly to feelings of muscle stiffness and involuntary muscle spasms, is a welldefined consequence of MS. It can be identified and assessed, for the most part, based on reported symptoms and findings on clinical examination and without sophisticated tests, and effective treatment options are available. However, although clinical practice guidelines for the management of spasticity in MS were published in 2003 by the Consortium of MS Centers, spasticity remains under-recognised and is often not optimally addressed for people with MS.
There are published data demonstrating that spasticity occurs frequently in people with MS. In a large survey of more than 30,000 people, by the North American Consortium of Multiple Sclerosis (NARCOMS) Registry, 84 percent of the people surveyed reported that they had spasticity. Male gender, older age, and longer duration of the disease were associated with an increased severity of spasticity. The level of spasticity also correlated with the level of disability related to MS.
Quality of life can be affected through troublesome symptoms and functional limitations, and severe spasticity may even lead to medical complications such as skin breakdown or contractures, where a limb can become fixed in one position. All of these elements underscore the need to recognise and address spasticity and its consequences.
However, it is sometimes difficult to identify spasticity among other symptoms. For example, a sensation of stiffness in the legs may result from spasticity, but also from abnormal sensations or from the weakness associated with MS. In addition, the presentation and severity of spasticity varies widely across people with MS and even in the same person over time. As a consequence of spasticity constantly fluctuating and evolving, any treatment or rehabilitation plan must adapt to the different stages that are unique to every individual, as with other MS related phenomena.
In many cases, initial interventions such as stretching, exercise and rehabilitation are helpful.
They also enhance the potential efficacy of other interventions such as medication, particularly when functional improvement is sought. Medications can also be useful and are usually safe, although the dosing and timing must be optimised to minimise potential side effects.
People with MS and healthcare providers are sometimes hesitant to consider more invasive treatments such as local injections and intrathecal baclofen therapy (ITB, a subcutaneously placed infusion pump, see page 15), although they can be very effective and well tolerated. Where available, a referral to a spasticity clinic with experience in the use of these therapies increases the chance of a successful outcome.
Exercises in a swimming pool can be part of a rehabilitation programme.
In summary, the same principles applied to the management of MS in general can and should be applied to the management of spasticity: information and education, early detection, thorough evaluation, careful treatment planning and goal setting and monitoring over time. And we should never forget that, in some cases, at least some spasticity should be preserved to avoid a loss of function – for some individuals a degree of spasticity serves as a functional crutch and helps them to walk or carry out other physical activities.
One key to enhancing the overall management of spasticity is to inform people with MS, caregivers and healthcare professionals about the symptom and its treatment. This is the purpose of this issue of MS in focus. After a review of what spasticity is and how it occurs, this issue of MS in focus will examine the methods used to evaluate the consequences of spasticity, and will present various management options and their results. We hope that readers will be enticed to seek further information or advice on this problem.
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