Treatment for stroke-related spasticity

After a stroke, the injury to the brain can cause muscles to contract or flex on their own when you try to use an arm or leg. The sensation is painful. It has been described as a "wicked charley horse." Because the muscle cannot finish its full range of motion, the tendons and soft tissue surrounding the muscle tighten. If not treated, spasticity can cause the muscle to "freeze" into an abnormal position, which can be very painful.

In the arm, spasticity can cause a balled-up fist, a bent elbow, or an arm pressed to the chest. Spasticity in the leg can cause a pointed foot, a curling toe, or a stiff knee. Spasticity can have a profound effect on the quality of life, making it difficult to walk or perform daily activities.

Treatment

Exercise and stretching are important treatments for spasticity. Therapists will work with you to increase your range of motion and help prevent permanent muscle shortening. You need to move the affected limb over and over again, either on your own or with the help of a therapist or a special machine.

In some cases cold packs and electrical stimulation are used on muscles. Casts or splints can be used to hold muscles in their normal position. This helps to prevent the muscles from contracting.

Medicines

For many years, oral medicines that help prevent spasms (antispasmodics), such as baclofen (Lioresal, for example), dantrolene (Dantrium), and tizanidine (Zanaflex), have been used to treat spasticity from stroke. These medicines relax tight muscles and stop muscle spasms. But they cause sleepiness and weakness and in some cases can cause hallucinations and sleep problems.

Two new treatments are being used with more success and fewer side effects. Botulinum toxin (Botox, Myobloc) and intrathecal baclofen are allowing doctors to target specific spastic muscles rather than use a medicine that affects the whole body.¹

Botulinum toxin injections directly into the spastic muscle block messages that cause the muscle to contract. The effect from one injection lasts about 3 months. Although botulinum toxin is approved for treating neck and shoulder spasms and facial wrinkles, it is not specifically approved to treat stroke-caused spasticity. This is called an unlabeled use.

Intrathecal baclofen is the same medicine that is used orally, but in this case, the medicine is delivered directly to the spinal cord through a small tube. The tube is implanted into the spinal cord by a surgeon, who also implants a small pump under the skin of the person's abdomen to deliver the medicine. Because the medicine is so targeted, the problems with sleepiness are avoided. This therapy is used mostly for people who have severe spasticity.

Surgery

Some people may need surgery to treat spasticity. For example, surgery may be needed to release the biceps or triceps tendon in the arm, lengthen the hamstring in someone who has problems walking, lengthen the Achilles tendon, or release the toe flexor muscles.

Citations

1. Browne BJ (2005). Rehabilitation of the stroke patient. In HF Conn et al., eds., Conn's Current Therapy, pp. 1016–1021. Philadelphia: Saunders.