SPASTICITY AND PARALYSIS

Treatment Options

Treatment for spasticity is often a mix of therapies and drugs. This approach is used to achieve the best results possible. It’s important to note that all therapies and drugs have potential risks and side effects. Be sure to weigh the risks and side effects against the benefits. Ask your doctor about the best treatment options for your needs.*

Stretching
Spasticity treatment often includes:

Full range-of-motion exercises at least three times a day
Gentle stretching of tighter muscles
Frequent repositioning of body parts.

Oral Medicines
There are many medicines that treat the general effects of spasticity. These drugs act on multiple muscle groups in the body.

Tizanidine (Zanaflex Capsules™), which is a drug that temporarily reduces spasticity by blocking nerve impulses. Tizanidine has been shown to decrease spasticity without a loss in muscle strength.

Oral baclofen acts on the central nervous system to relax muscles. It also decreases the rate of muscle spasms, pain, tightness and improves range of motion. Baclofen is not indicated for patients with spasticity due to problems with the brain (of cerebral origin).

Benzodiazepines (Valium® and Klonopin®) are a group of drugs that act on the central nervous system to relax muscles and temporarily decrease spasticity. These drugs can be very sedating for patients with stroke and other acquired brain injury.

Dantrolene sodium (Dantrium®) acts directly on the muscle by blocking the signals that cause muscles to contract. The use of Dantrolene can lessen muscle tone.

Injections
Injections of botulinum toxin (Botox®, Myobloc® and Dysport®) prevent the release of chemicals that cause muscle contraction. These shots target only specific limbs or muscle groups affected by spasticity. This helps control side effects to other areas of the body. But, when side effects are present they may include mild soreness where you received the shot and weakness. A single shot of botulinum toxin usually takes full effect within two to four weeks after injection. Treatment may need to be repeated as often as every three months.

Another shot that can temporarily control and provide relief for spasticity is Phenol. Phenol destroys the nerve pathways that are involved with spasticity of a specific muscle group. The benefit of using phenol is that you see the effects right away. The relief provided by Phenol can last from six to 36 months. Side effects may include pain during injection, a burning/tingling sensation and swelling of the injected area.

Botox® (onabotulinumtoxin) was recently approved by the FDA specifically for use in patients experiencing upper limb post-stroke spasticity.

Intrathecal Medication
Intrathecal Baclofen™ (ITB) therapy delivers Lioresal Intrathecal®, a liquid form of baclofen, directly into the spinal fluid. A programmable pump is surgically placed just below the skin near the abdomen. The pump constantly delivers small doses of medicine. Side effects are minimal because the drug is delivered directly to the area of the nervous system where baclofen works and does not circulate throughout the body. However, possible side effects may include weakness, nausea and headache.

Surgery
Surgery can be done on the muscles or the tendons and joints. Surgery may block pain and restore some movement.

Not all treatments are suitable for everyone. Doctors will try to tailor spasticity treatments to each person, by looking at the extent of the problems, individual symptoms and personal lifestyle goals. Your doctor will also help you understand how much medicine you need and the side effects.

*National Stroke Association does not endorse or recommend one drug or treatment over another.