On September 13th, we went Live ith Dr. Bennett Myers, Co-Director of DENT’s new Spasticity Clinic. Spasticity is, unfortunately, a prevalent problem that we see at DENT Neurologic Institute.
What is Spasticity?
In its broadest terms, spasticity refers to abnormal muscle contraction that is produced by an injury to the brain and spinal cord. Often, it can be confused with muscle spasm.
All of us have had muscle spasms in our neck, back, or arms. Muscle spasm also refers to a kind of abnormal muscle contraction. It is fundamentally different than spasticity.
The difference is not always evident to most people.
“Neurologists who are skilled in diagnosis and assessing patients can usually pick [the differences] up quite readily,” explains Dr. Myers. “There needs to be some sort of injury to the brain or spinal cord to produce spasticity.”
Most Common Causes + Diagnosis
The most common causes of spasticity that we often see are diseases of the central nervous system, like Multiple Sclerosis, Cerebral Palsy, or brain tumors. Spasticity is not a disease in itself; it’s more of a symptom of a lot of different types of conditions.
Most patients who show up to the Spasticity Clinic already have a diagnosis for whatever is wrong with their central nervous system that is reducing the spasticity.
“Since most patients who come to the clinic already have a diagnosis, our focus at the DENT Spasticity Clinic is focusing on management of the spasticity,” explains Dr. Myers.
Why do you need to manage spasticity?
Not all spasticity needs management.
“Some patients will have some weakness in their legs,” explains Dr. Myers, “and the spasticity is helpful to them. It helps keep them upright and enables them to walk.”
If you over treat the spasticity, you can take someone who can walk and treat the spasticity, and now their legs are weaker, and they are unable to walk.
“We always have to be very clear as to what we are trying to accomplish when treating the spasticity,” says Dr. Myers. When treating someone with spasticity, the specialists at DENT first identify what the cause is. Next, they figure out if the spasticity is causing problems for the patient and what those problems are.
What is the goal of treatment?
Spasticity can be quite painful. Relieving pain for patients could be a goal of treatment. Sometimes, spasticity is not helpful, and it can interfere, which is more common in the arms and the hands.
“For example, people [who] have had strokes. Maybe they are not paralyzed. There is a weakness, but they have some movement. The muscles become very spastic from the injuries to the brain, and the spasticity interferes with function,” says Dr. Myers. “So, our goal of treatment in that individual may be to improve function.”
Those who have more severe spasticity, it is not only painful, but it can be hard for them to care for themselves. “If a patient has severe spasticity of their arm, so their arm is curled up very tight, you can imagine it is hard t get a shirt on and off,” says Dr. Myers. “A goal of treatment for that individual may be to relieve the spasticity to make it easier for the patient to get dressed.”
What is a contraction or contracture?
We often treat spasticity to prevent contracture formation, which is scarring at the joints.
“An example of this is if I took my arm, put it in a sling, and leave it there for three months. Later, if I took the sling off, I might not be able to move my arm at all,” says Dr. Myers. “Why is that? Neurologically I am fine, but the problem here is that the joints have stiffened up so severely and scarred down that now they do not move anymore.”
Someone who has had the issue after any type of injury to the brain or spinal cord will eventually have their joints tighten up and scar. The mentioned injury can be a painful situation. Often, preventing contracture formation is a goal when treating spasticity.
Steps take to diminish spasticity
We don’t treat spasticity for the sake of it. We want to relieve pain, improve function, prevent contracture formation, and make our patients’ lives better in some way.
The treatment plan depends on how much of the body is involved and how bad the spasticity is.
“Let’s take someone who has mild to moderate degree of spasticity, for example. The first thing we try is physical therapy, occupational therapy, stretching, and regular exercise,” Dr. Myers explains. “We will see if we can get an adequate handle on the spasticity without resorting to any medication.”
The treatment suggestions mentioned by Dr. Myers do not have any side effects. Our first form of treatment is trying to manage spasticity without an invasive or medication approach. “When we can be successful in that rate, usually everybody is quite happy,” says Dr. Myers.
“Often, that is not enough, and we need to be more interventional,” Dr. Myers adds in.
The next step will often be medication. There are several medications that we commonly use that relieve spasticity. These usually work best in people where the spasticity is relatively widespread, or is severe.
Most medicines that help with spasticity have the same side effect: sleepiness.
“If I am making them semi-comatose where they’re sleeping 20 hours as a side effect, I am not doing them any favors,” says Dr. Myers. “That is often our limitation to using medication. If it is a high enough dose, I can relieve an awful lot of spasticity. However, if someone is sleeping all the time, then I haven’t improved their quality of life, which is the whole goal of why I am treating the spasticity.”
Why choose DENT?
The DENT Neurologic Institute is among the largest, most comprehensive neurology practices in the United States. We are focused on providing superior clinical care, advanced diagnostic services, clinical research, and education.
The breadth and scope of our clinical expertise has allowed the creation of our specialty clinics. Every clinic has the same mission: to provide a disease-specific approach to treatment. This unique and integrated model has strengthened our standards of care, quality measurement, outcomes, and participation in clinical research.
To make an appointment, please call 716-250-2000. More information about our new Spasticity Clinic will be released soon.