Spasms and Stiffness in Multiple Sclerosis

Spasms and stiffness (collectively called spasticity) are one of the most common symptoms of MS, with as many as three-quarters of people with MS having signs of spasticity at some stage.

Spasticity can affect many aspects of daily life. For instance, it can affect walking, sitting in a chair or turning over in bed. It can affect sexual activities and overall comfort and mood. It can range from mild to severe and change over time, often from day to day, hour to hour.

What is Spasicity?

In order to move normally, one group of muscles relax while another contracts. Spasticity results from more than one group of muscles contracting at the same time, causing stiffness or spasms. Spasticity can lead to a range of symptoms, which can be uncontrollable, sometimes embarassing and often painful.

Stiffness

Stiffness of the limbs is common and can make it difficult to perform normal activities, particularly delicate movements of the hand and fingers. If the leg muscles are affected it can make walking difficult. On a more positive note, people sometimes find that the stiffness they experience can compensate for muscle weakness and can make standing, walking or transferring easier. Despite limbs being stiff, it is also possible that the muscles may also be weak.

Spasms

These are uncontrollable muscle contractions and can be painful. They can be a particular problem at night and sometimes are powerful enough to kick your partner out of bed! Limbs may shoot away or bend upwards towards the body or may make your back arch off the bed or chair. The effort of having spasms, through the day and night can result in people feeling fatigued.

Pain

Pain can be associated with spasticity, but it not always present. If pain is occurring, it can be associated with spasms, stiff muscles or from poor sitting and lying positions.

Managing Spasticity

Managing spasticity effectively will involve a combination of drugs, physiotherapy, alternative therapies, and avoiding factors that trigger or make your symptoms worse.

This involves many people and may take time to get right. Medicines are taken alone or in combinations, and it may take several attempts to find the right drug and dose.

Triggers: Spasticity can be made worse by things like: infections, constipation, a full bladder, pain (such as an ingrowing toenail), pressure sores or skin redness, poor posture, changes in humidity or temperature, tight clothing or even coughing and sneezing. Advice and assistance in managing the things that make spasticity worse can be given by an MS nurse, continence advisor, GP, district nurse, neurologist, occupational therapist and physiotherapist.

Drug treatments

Baclofen (Lioresal) tablets	The most commonly used drug for spasticity. It is a muscle relaxant that works in the cental nervous system. Baclofen is started at low doses and gradually increased to find the dose that is most effective. Side-effects can include weakness, drowsiness and dizziness.
Liquid (Intrathecal) Balofen	Used for severe spasticity, liquid baclofen can be delivered directly into the spinal fluid surrounding the spinal cord using an automatic pump. Because the drug is targeted directly to the part of the body where it works and is given continuously, lower doses can be used and side-effects reduced.
Tizanidine (Zanaflex)	This works on the central nervous system and needs to be introduced slowly to avoid side-effects. It is claimed that Tizandine does not cause as much muscle weakness as Baclofen, but this varies from person to person. Side effects may include liver problems, so regular blood tests are required.
Diazepam (Valium)	Can be used on its own or in combination with other drugs. It can be useful to use before going to sleep if spasms are particularly troublesome at night. Side-effects may include drowsiness and dizziness.
Dantrolene (Dantrium)	Often used when other drugs (alone or in combination) fail to control spasticity adequately. This drugs works directly on muscles lowering their ability to contract. Side-effects can include liver damage and blood abnormalities, therefore regular monitoring is needed for its long-term use.
Botulinum toxin (Botox)	Injected directly into a muscle, this has been used for a number of years to reduce muscle tension and to treat 'focal' spasticity. It lasts for 2-4 months. Side effects can include muscle weakness.
Phenol or alcohol injections	Occasionally used to block nerves to problem muscles. A health professional may inject phenol straight into the spinal fluid.

Anecdotes from some people with MS suggest that cannabis can relieve spasticity and pain. Currently, as an illegal drug, it cannot be prescribed. Clinical trials were started in 2000 to establish its effectiveness in managing spasticity.

Occasionally in cases of severe spasticity and when all else has failed, permanent relief can be obtained through surgery to cut tendons or nerves in order to relax cramped up muscles.

Non-drug treatments

Physiotherapy and occupational therapy

Physiotherapy is aimed at strengthening, stretching and relaxing muscles, increasing joint movements and improving circulation. A physiotherapist may provide a series of specially tailored exercises to be done at home.

Exercise in water (hyrdrotherapy) can be used to relax limbs; application of cold packs (cryotherapy), appropriate positioning and relaxation techniques such as mediation or yoga can also help.

Massage can help muscle stiffness, but may make spasms worse.

An occupational therapist can help alleviate spasticity by providing equipment to help your daily activities. Sometimes they can suggest braces or splints to make movement easier or more comfortable. In conjection with a physiotherapist they can suggest appropriate equipment to improve sitting posture. They can also assess your day-to-day activities and suggest new ways of doing tasks, to keep the possibility of exacerbating or triggering your spasticity to a minimum.

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