Treatment Overview
Living with spasticity can feel like your body is fighting against you. For many people, it manifests as stiff, tight muscles that resist movement, or sudden, uncontrollable spasms that can be painful and embarrassing. Simple tasks like walking, picking up an object, or even finding a comfortable sleeping position can become daily challenges. This condition, often resulting from stroke, multiple sclerosis, cerebral palsy, or spinal cord injuries, creates a constant tension that can limit independence and mobility.
Treatment is critical not only to relieve pain but to prevent long-term complications such as permanent muscle shortening (contractures) or skin breakdown. The goal is to relax the muscles enough to improve function and comfort without making them so loose that they become weak. Because spasticity varies widely from mild stiffness in one arm to severe tightness in the legs, treatment plans are highly individualized. Doctors assess the underlying cause and the specific muscles involved before recommending medication (National Institute of Neurological Disorders and Stroke, 2023).
Overview of treatment options for Spasticity
The management of spasticity generally follows a stepped approach. Physical therapy and stretching are the foundation, but medications are almost always necessary when stiffness interferes with daily life or sleep. The primary goal of medical treatment is to reduce abnormal muscle tone and the frequency of spasms.
Medical interventions are categorized based on whether the spasticity is generalized (affecting the whole body or large areas) or focal (affecting specific muscles). For generalized spasticity, oral medications are typically prescribed. For focal issues, injections are often the preferred method. In severe, chronic cases where oral medications fail or cause too many side effects, surgical implantation of a medication pump may be considered to deliver drugs directly to the spinal fluid.
Medications used for Spasticity
For generalized spasticity, skeletal muscle relaxants are the standard first-line treatment. Baclofen is the most commonly prescribed medication in this class. It is widely used for spasticity related to spinal cord injury and multiple sclerosis. Clinical experience suggests that while effective, finding the right dose often requires a gradual increase to balance relief against side effects.
Tizanidine is another frequently used oral medication. It is often chosen for patients who need relief but want to avoid the significant muscle weakness that can sometimes occur with other drugs.
Benzodiazepines, such as diazepam or clonazepam, are also effective muscle relaxants. However, due to their sedating nature and potential for dependency, they are often reserved for nighttime use or short-term relief.
Dantrolene is a unique medication often used as a second-line option, particularly for patients who have suffered a stroke. Unlike the others, it acts directly on the muscle tissue rather than the nervous system.
For focal spasticity, injections of onabotulinumtoxinA (botulinum toxin) are the gold standard. These injections target specific tight muscles, such as a clenched fist or a stiff ankle. Patients can expect relief to begin within a few days of the injection, with benefits lasting approximately three months before retreatment is needed (Mayo Clinic, 2023).
How these medications work
Most oral spasticity medications act on the central nervous system. Baclofen and tizanidine reduce overactive nerve signals in the spinal cord and brain, allowing muscles to relax.
Benzodiazepines enhance the calming effect of the neurotransmitter GABA on the nervous system, including muscle control pathways. Dantrolene works uniquely by blocking calcium release inside muscle fibers, which prevents forceful contraction. Botulinum toxin temporarily paralyzes specific muscles by blocking the nerve-to-muscle chemical signal (American Association of Neurological Surgeons, 2024).
Side effects and safety considerations
Common side effects of oral spasticity medications include drowsiness/sedation (affecting driving/work) and muscle weakness, which can increase the risk of falls if beneficial stiffness is lost.
Baclofen carries a specific risk: never stop abruptly, as sudden withdrawal can cause seizures and hallucinations. Tizanidine requires blood pressure and liver function monitoring due to potential effects. Dantrolene also risks liver toxicity.
Botulinum toxin injections are generally safe, possibly causing temporary weakness in nearby muscles or flu-like symptoms. Seek immediate medical care for difficulty breathing or swallowing, which signals a severe reaction or overdose. Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- American Association of Neurological Surgeons. https://www.aans.org
- Mayo Clinic. https://www.mayoclinic.org
- National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov
- MedlinePlus. https://medlineplus.gov
Medications for Spasticity
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Spasticity.