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After a Stroke: Medications to Reduce Arm Spasticity

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When it comes to stroke rehabilitation, one medication doesn’t fit all. Your stroke rehab team will work with you to find out which medications, if any, can improve stiffness after a stroke. It's important to remember these medications are not a cure. They are ongoing treatments that relieve the symptoms of spasticity.

"There are no medications that have been well proven -- in large, well-designed clinical trials -- to directly help with motor rehabilitation beyond their effect on spasticity," says Rebecca Gottesman, MD, PhD, Gottesman is assistant professor of cerebrovascular neurology at Johns Hopkins Hospital in Baltimore.

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When spasticity occurs, muscles remain tight. This can cause pain, abnormal posture, and uncontrollable movements. Nearly one out of every three patients may have spasticity after a stroke. The spasticity can occur anywhere in the body, but it is most common in the arm. Activities like dressing and eating may become very difficult.

But a variety of treatments, including medications, can help. Which therapies you use depends on the extent and severity of your spasticity. You may need more than one type to manage the problem. And for best results during stroke rehab, medications in combination with therapy such as stretching and strengthening exercises work best and are typically the first line of treatment. Without daily physical rehab, the muscles will remain contracted and joints become immobile. 

Oral Medication After a Stroke

If you have severe abnormal tone – an abnormal increase in muscle tension and a reduced ability of the muscle to stretch -- and all limbs are involved, oral medications may be the best option, Bogey says. These medications act on many muscle groups at the same time. However, they can also cause systemic side effects like sleepiness. "Patients tend to get sedated before they see benefits from these medications," Stein says. “It’s not that they’re not of some value, but the side effects generally outweigh the clinical benefits."

Oral medications for spasticity include medications such as these:

  • Baclofen (Lioresal) relaxes muscles by acting on the central nervous system. It can decrease muscle spasms, tightness, and pain and improve range of motion. Side effects may include confusion or hallucinations, slight sedation compared to other treatments , loss of muscle tone or coordination, and weakness in unaffected muscles. 
  • Tizanidine hydrochloride (Zanaflex) reduces spasticity by blocking nerve impulses. However, it does not lessen muscle strength. Because it lasts for a short time, tizanidine is best used only when you need it for relief or to be able to complete certain activities. Side effects may include low blood pressure, dry mouth, and sleepiness. 
  • Benzodiazepines (Valium and Klonopin) relax muscles and decrease spasticity for a brief time. They do this by acting on the central nervous system. Side effects may include drowsiness, muscle weakness, mental impairment, or dependence. 
  • Dantrolene sodium (Dantrium) blocks signals that make muscles contract. This may reduce muscle tone. Side effects may include depression, weakness, drowsiness, nausea, vomiting, dizziness, diarrhea, and rarely liver failure.

 

 

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