Spasticity as a Symptom of Multiple Sclerosis

Muscles spasms and stiffness are common with this disease

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At some point in the course of their disease, the majority of people with multiple sclerosis (MS) experience spasticity, a term that describes an increase in your muscle tone. While that may sound like a good thing if you're looking to tone up, what it really means is that your muscles don't relax as much or as easily as they should, resulting in involuntary muscle spasms. Because of this, spasticity affects your movement, making it a motor symptom rather than a sensory symptom like pain or numbness.

Types of Spasms in MS
Verywell / Cindy Chung

Symptoms

Though it can occur in any muscle in your body, spasticity tends to most often affect the legs. You may also experience it in your arms, the muscles in your back and trunk, and near or in your joints. Spasticity also tends to be asymmetrical, meaning you may notice that it's worse or happens more often on one side of your body than the other.

The symptoms you may experience when your muscles are spasming include:

  • Stiffness
  • Difficulty moving the affected area
  • A feeling of heaviness
  • Tightness
  • Pain that ranges from mild to severe
  • Cramping
  • Achiness

Your spasms may be worse when you wake up in the morning or during the night when you're trying to sleep.

Like everything in MS, spasticity affects everyone differently, and it can manifest in a variety of unpredictable ways in each individual—even over the course of a day.

Types of Spasms

There are several kinds of muscle spasms that can occur in MS, including:

  • Extensor spasms: These occur when a limb, usually your leg, stiffens and you can't bend the joint, which makes the limb jerk away from your body. These spasms usually affect the quadriceps, the large muscles on the front of your thigh, causing your lower leg to straighten. Spasms of the adductor muscles, located on the inside of the upper leg, are rarer but can cause your legs to close together tightly, making it difficult to separate them.
  • Flexor spasms: With these spasms, your limbs bend (contract) toward your body. This type of spasm almost always affects your legs, especially the hamstrings or hip flexors.
  • Clonus: This is the term for what happens when your muscles jerk or twitch repeatedly, similar to what happens in some types of seizures. The most common forms of clonus are when your foot taps rapidly and repetitively on the floor, or when your knee or ankle jerks repeatedly after stimulation, such as tapping at the joint (rather reacting with the normal response of one tap or jerk).
  • Stiffness: This can be thought of as mild spasticity. While not as dramatic as some of the spasms described above, when muscles are slow to relax, it can cause problems walking or using your hands and fingers to perform delicate movements. In some cases, the stiffness may not pose a huge problem. In other cases, it can cause problems with mobility or be painful enough to interfere with your daily life.

One classic manifestation of spasticity is the MS hug, which occurs when the tiny muscles between your ribs spasm.

Causes

Like most other MS symptoms, spasticity is primarily caused by demyelination, which in this case increases your muscle tone. Because of slow or interrupted nerve impulses, your muscles may respond by not relaxing as quickly as they should, tightening involuntarily, or staying contracted for long periods of time or even constantly.

There are a variety of factors that can aggravate spasticity, acting as a trigger for spasms, like:

  • Infections, such as respiratory, urinary tract, or bladder infections
  • Pain
  • Sores or skin breakdown
  • Quick or sudden movements
  • An increase in internal temperature (for example, because of a fever or excessive exercise)
  • A full bladder
  • Binding, rubbing, or irritating clothes
  • Humidity
  • Being too hot or too cold
  • Constipation
  • Problems with posture
  • Extreme environmental temperatures
  • Stress, worry, or anxiety

Effects

For many people, spasticity can be an annoyance or a passing problem that hinders smooth walking one day but is absent the next. It may just be that walking quickly or climbing stairs is harder than it was previously. Others may actually benefit from mild spasticity or stiffness, as it can counteract some degree of muscle weakness and make it easier to stand or walk. 

That said, for some people, severe forms of spasticity or stiffness can cause a problem with mobility, as walking becomes difficult or impossible. For example, some spasms can be aggravated when moving from your bed into a wheelchair.

In addition, some extensor spasms can be so sudden and strong that you can fall out of a chair or bed. Flexor spasms can cause your limbs to be held in painful positions and lead to secondary joint pain.

Treatment

There are many different treatments for spasticity, depending on the type of spasms you have, the severity, and their responsiveness to medication. The goal of treatment is to reduce your muscle tone enough to improve your motor function, but not so much that your muscles become weak, potentially causing safety issues.

This is why it's important for you to work closely with your healthcare team to find the best treatment plan for your individual needs. Use our Doctor Discussion Guide below to start a conversation with your doctor about the right treatment for you.

Multiple Sclerosis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Medications

The first line of treatment for spasticity is oral medications, including:

  • Baclofen
  • Zanaflex (tizanidine)
  • Neurontin (gabapentin)
  • Benzodiazepines, such as Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam)
  • Dantrium (dantrolene)

The type of medication your doctor prescribes will depend on the location, type, and severity of your spasms. You may even end up needing a combination of some of these medications.

Magnesium for Nighttime Spasms

For nighttime spasms, your doctor may first try having you take 250 mg to 500 mg of magnesium before bed. Don't initiate this treatment—or any other supplementation—on your own, though; supplements can interfere with medications you're taking or, in the case of magnesium, cause any bowel frequency or urgency that you already have to worsen.

If none of these drugs are effective or your situation calls for a different treatment, other approved medication options include:

  • Intrathecal baclofen: This implanted pump injects baclofen into the space in your spinal column that contains cerebrospinal fluid.
  • Botulinum toxin injections: An evidence-based review by the American Academy of Neurology (AAN) found that botulinum toxin injections, specifically Botox (onabotulinumtoxinA), Dysport (abobotulinumtoxinA), and Xeomin (incobotulinumtoxinA), are effective in reducing muscle tone and improving passive function in adults with upper-limb spasticity. Botox and Dysport are also effective in decreasing lower-limb spasticity. The AAN concluded that the fourth formulation of botulinum toxin injection, Myobloc (rimabotulinumtoxinB), probably decreases upper-limb spasticity as well.

Non-Pharmacologic Treatments

Since they can give you additional relief, there are some non-pharmacologic treatments that you can consider trying as well, such as:

  • Avoiding triggers: Your medication won't be as effective if you aren't working to avoid or eliminate the triggers mentioned above. For instance, you can learn some relaxation techniques to use when you're under stress, make sure you get enough fiber in your diet, practice good posture, and stay away from potentially irritating clothing.
  • Physical therapy: This usually involves stretching—either passively (someone stretches your limbs for you) or actively (you stretch your muscles)—or hydrotherapy (exercising in water). You can also learn how to maintain good posture, an important element in minimizing spasticity symptoms.
  • Occupational therapy: An occupational therapist can help you with aids you may need, such as braces, adapted seating, wheelchairs, and aids for sleeping or to improve your posture.

Managing your triggers, stretching, and maintaining good posture can help you minimize your spasticity symptoms enough that you may not even need medication.

Complementary and Alternative Medicine (CAM)

Many people experiencing spasticity try complementary and alternative methods to relieve it, including:

While there is limited scientific evidence to back up the use of these methods, some people find them helpful, and these therapies may have other feel-good benefits as well.

Cannabidiol Oromucosal Spray

An oral spray derived from cannabis called Sativex (nabiximols) is another potential option to treat spasticity. A 2019 systematic review of observational studies on this particular use of this product found that the spray is effective and safe as an additional treatment for MS patients who don't respond well to or can't tolerate the regularly-prescribed medications for spasticity.

Nearly 42 percent to 83 percent of patients saw at least a 20 percent reduction in their spasticity symptoms within the first month of treatment (the average dose was five to six sprays per day), and this decrease continued for six to 12 months.

Adverse effects such as dizziness, drowsiness, nausea, and fatigue affected 10 percent to 17 percent of the participants, but these effects decreased over time. The researchers also found no evidence that long-term use of the spray led to abuse or tolerance development.

Sativex isn't currently approved in the United States, but it's available in a number of other countries. If cannabis spray is something you're interested in trying, don't use it on your own—talk to your doctor about how you can obtain it and what dosage is right for you.

Surgery

In the most severe cases of spasticity, there's a surgical option in which your nerves are severed. However, this is rarely needed or used.

A Word From Verywell

When managing your spasticity, try your best to keep moving, stretching, avoiding certain triggers, and engaging in therapies like physical therapy or hydrotherapy. Be sure to treat your mind too. Let your doctor know if your spasticity is affecting your quality of life so that you both can work on a plan that will help you feel your best.

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