What treatment options are available for spasticity?

Spasticity is increased, involuntary, and unwanted muscle tension resulting from a loss of function in motor neurons. This increased and uncontrolled muscle tension can be associated with various symptoms, each of which is treated differently.

Intensive physical therapy (and the use of therapeutic exercise equipment) is the first and most important form of treatment for maintaining muscle mobility, reducing muscle tone, and reducing complications of spasticity (such as tendon shortening, painful joint changes, and narrowing of joint capsules, among others).

There are also several pharmacological options for treating spasticity. In cases of mild spasticity, treatment with 4-aminopyridine can improve spastic gait abnormalities, at least in some patients. Studies on multiple sclerosis (a condition in which spasticity can also occur) have shown that 4-aminopyridine can positively influence signal transmission in certain nerve pathways and reduce spastic gait disturbances. Based on the same principle, the use of 4-aminopyridine may also be beneficial for improving walking in ALS. In cases of severe spasticity and distressing symptoms (e.g., spasticity-related pain), treatment with antispastic medications (spasmolytics) is an option. These medications are also referred to as “muscle relaxants.” Baclofen and tizanidine are established antispasmodics that can reduce muscle tone.

The use of cannabis-based medications is becoming increasingly important. Tetrahydrocannabinol and cannabidiol (THC:CBD) can also help reduce the symptoms of spasticity. THC:CBD is a treatment option when antispasmodic medications (baclofen, tizanidine) are ineffective or not well tolerated.

In cases of particularly severe spasticity affecting individual muscle groups (“focal” spasticity resulting in “foot drop,” a “spastic fist,” or adductor spasticity), treatment with botulinum toxins can be an important treatment option. Botulinum toxins are a group of highly effective “muscle relaxants” that take effect when the medication is injected into the muscles. An advantage of botulinum toxins is their high efficacy with few side effects—the medication remains in the muscle and does not enter the circulatory system or the rest of the body. A disadvantage is the localized nature of its effectiveness—the medication acts only in the muscle into which it is injected. The injection can be painful and must be repeated every three to four months.