Muscle Spasticity (Spastic)

A form of muscle hypertonia associated with upper MOTOR NEURON DISEASE. Resistance to passive stretch of a spastic muscle results in minimal initial resistance (a "free interval") followed by an incremental increase in muscle tone. Tone increases in proportion to the velocity of stretch. Spasticity is usually accompanied by HYPERREFLEXIA and variable degrees of MUSCLE WEAKNESS. (From Adams et al., Principles of Neurology, 6th ed, p54)

Also Known As:

Networked: 2019 relevant articles (158 outcomes, 231 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Cerebral Palsy (Spastic Diplegia)
2.	Stroke (Strokes)
3.	Pain (Aches)
4.	Paresis (Hemiparesis)
5.	Spasm (Spasms)

Experts

1.	Yasue, H: 12 articles (09/2001 - 01/2000)
2.	Kugiyama, K: 11 articles (09/2001 - 01/2000)
3.	Ogawa, H: 11 articles (09/2001 - 01/2000)
4.	Deltombe, Thierry: 9 articles (10/2015 - 01/2004)
5.	Park, Eun Sook: 9 articles (11/2014 - 11/2002)
6.	Gracies, Jean-Michel: 8 articles (10/2015 - 03/2004)
7.	Yoshimura, M: 8 articles (09/2001 - 02/2000)
8.	Yoshimura, Michihiro: 7 articles (12/2015 - 09/2003)
9.	Picelli, Alessandro: 7 articles (01/2015 - 05/2012)
10.	Smania, Nicola: 7 articles (01/2015 - 05/2012)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Muscle Spasticity:

1.	Botulinum Toxins (Botulinum Toxin)IBA 01/01/2012 - "Botulinum toxin injection of the distal oesophagus may be effective in the treatment of NCCP and spastic oesophageal motility disorders. " 12/01/1997 - "Our results suggest that botulinum toxin A represents an effective and safe therapeutic substance for the treatment of pediatric patients suffering of focal motor problems due to dystonic or spastic muscular hyperactivity." 09/01/2005 - "Efficacy of botulinum toxin A, serial casting, and combined treatment for spastic equinus: a retrospective analysis." 05/15/2005 - "Variability and predictability of functional efficacy of botulinum toxin injection in leg spastic muscles." 12/01/2004 - "Efficacy of botulinum toxin A, serial casting, and combined treatment for spastic equinus: a retrospective analysis."
2.	Type A Botulinum Toxins (Botulinum A Toxin)FDA Link 07/10/2015 - "Botulinum toxin type A (BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. " 05/01/2001 - "In recent years, botulinum toxin type A (BT) has been found to be effective in the treatment of various spastic disorders of smooth muscle in the upper and lower gastrointestinal tract. " 10/01/2002 - "Botulinum toxin type A treatment using doses based on spasticity severity seems to be safe and effective in the treatment of spastic toes, and further study is warranted." 01/01/2014 - "Meaningful improvement in walking performance after Botulinum neurotoxin A (BoNT-A) in chronic spastic patients." 07/01/2003 - "At least two randomized controlled trials (RCTs) have shown botulinum toxin type A (BtxA) to be efficacious and safe when used in the management of muscle spasticity in children. "
3.	BaclofenFDA LinkGeneric 06/01/2004 - "Intrathecal baclofen (ITB) appears most beneficial in severe spastic tetraparetics or tetraplegics, but the evaluation of the outcome of ITB and the benefit of the treatment are largely subjective. " 04/01/2006 - "Conclusion.  Although we did not show any improvement in muscle performance, intrathecal baclofen did improve daily quality of life, even in spastic patients who were able to walk." 11/01/2014 - "Several decades after Penn and Kroin (1984) proved that continuous infusion of intrathecal baclofen reduced spinal cord spasticity, numerous studies have demonstrated the benefits of ITB therapy and proven its effectiveness in modulating and reducing spastic tone. " 01/01/2011 - "Prospective 12-month study of intrathecal baclofen therapy for poststroke spastic upper and lower extremity motor control and functional improvement." 04/01/2000 - "Fourteen spastic MS patients were examined in a placebo controlled double-blind, cross-over trial of oral baclofen treatment. "
4.	tizanidine (Zanaflex)FDA LinkGeneric 11/01/1994 - "Tizanidine was evaluated in a prospective, double-blind, randomized, placebo-controlled trial in 187 patients with MS. Taken orally for 9 weeks and preceded by a titration phase for a period of 3 weeks starting at 2 mg daily, tizanidine produced a significant reduction in spastic muscle tone compared with placebo treatment. " 11/01/2004 - "We conclude that tizanidine is useful for the treatment of refractory sleep disturbance in spastic quadriplegic patients." 11/01/1989 - "Clinical studies have shown that modified release tizanidine improved spasticity and disability in approximately 94% and 79%, respectively, of spastic patients. " 11/01/2004 - "Based on these drug actions, we administered tizanidine to 21 spastic quadriplegic children with severe sleep disturbance not improved by conventional therapies. " 01/01/2014 - "We investigated whether a pharmacological intervention using Tizanidine, an anti-spastic medication acting as an α2-adrenergic agonist, could lead to improvements in walking endurance. "
5.	Diltiazem (Cardizem)FDA LinkGeneric 03/01/1996 - "Diltiazem (10(-5) mol/L) partially suppressed the augmented [Ca2+]i signal in the spastic arteries, whereas it did not affect the curve in the control group. " 04/01/1989 - "Both diltiazem (D) and nifedipine (N) have been shown to be effective in the treatment of spastic angina, but they sometimes prove inadequate, even in high doses. " 03/01/1986 - "Clinical and electrical monitoring showed that the efficacy of bepridil is comparable to that of diltiazem in treatment of spastic angina." 11/01/2010 - "Comparison of the effects of long-acting nifedipine CR and diltiazem R in patients with vasospastic angina: Aomori coronary spastic angina study." 04/01/1989 - "[A combination of nifedipine and diltiazem in the treatment of refractory spastic angina]."
6.	Nifedipine (Adalat)FDA LinkGeneric 11/01/1977 - "Further clinical studies have to be done to clarify if the spasmolysis by nifedipine may be important in the treatment of spastic or hypertonic motility disorders of the LES and the esophagus." 03/01/1989 - ""Hypotonic" disorders of the cerebral blood flow are less favourable for corinfar treatment as compared with the "spastic" disturbances." 01/01/1988 - "Nifedipine treatment as an independent therapy is primarily indicated to patients showing spastic rheoencephalographic changes." 04/01/1989 - "Both diltiazem (D) and nifedipine (N) have been shown to be effective in the treatment of spastic angina, but they sometimes prove inadequate, even in high doses. " 04/01/1987 - "Either nifedipine or hyoscyamine would appear to be potentially effective for the treatment of oesophago-spastic and other hypertensive motor disorders, but hyoscyamine may lead to prolongation of acid clearance from the oesophagus."
7.	abobotulinumtoxinAFDA Link 07/01/2009 - "BoNT-A (Dysport) was injected into several upper limb spastic muscles in a group of 20 patients. " 01/01/2014 - "To analyze the efficacy of repeated use of dysport in children with spastic forms of cerebral palsy (CP). " 01/01/2010 - "53 patients with the syndrome of spastic torticollis (ST) were examined to assess the nature and dynamics of pain syndrome during the treatment with dysport. " 01/01/2010 - "[Pain syndrome in patients with spastic torticollis before and after the treatment with dysport]." 01/01/2010 - "The objective is to study the effect of dysport injections on the clinical and electromyographic changes in 35 patients (mean age 5,3+/-2,0 years) with spastic forms of cerebral palsy (26 with spastic diplegia, 9 with hemiparetic form) with equinus and equinovarus deformity. "
8.	Dantrolene (Dantrium)FDA LinkGeneric 08/01/1986 - "Thus, dantrolene offers a unique advance in the therapy available for the treatment of hypercatabolic disorders and is also useful in the treatment of muscle spasticity of various aetiology." 07/01/1976 - "[Clinical study of dantrolene sodium in the treatment of spastic and dystonic syndromes]." 08/01/1986 - "Long term dantrolene therapy has been associated with hepatic toxicity and may cause problems in patients treated for disorders of muscle spasticity. " 08/01/1986 - "Dantrolene is well established in the treatment of patients with muscle spasticity where it generally improves at least some of the components of spasticity (i.e. " 04/01/1981 - "The effect of dantrolene sodium in relation to blood levels in spastic patients after prolonged administration."
9.	Nimodipine (Modus)FDA LinkGeneric 02/01/1996 - "The cerebral blood flow is improved by the effect of nimodipine on non-spastic arteries. " 01/01/1988 - "Haemodynamic effectiveness of nimodipine on spastic brain vessels after subarachnoid haemorrhage evaluated by the transcranial Doppler method. " 04/01/2011 - "When the traditional treatment options either medical or interventional, fail to reverse the vasospasm, continuous intra-arterial infusion of nimodipine through catheters direct in the spastic arteries, presents a promising treatment modality. " 01/01/2011 - "When the traditional treatment options, either medical or interventional, fail to reverse vasospasm, continuous intraarterial infusion of nimodipine through catheters directly into the spastic arteries presents a promising treatment modality. " 01/01/2013 - "Nimodipine's vasodilatory effect was smaller in spastic than in non-spastic vessels (n = 12; p < 0.05), which we assume to be due to structural changes in the vessel wall. "
10.	Ergonovine (Ergometrine)IBA 02/01/1991 - "Though postoperative coronary arteriography showed no anatomical changes compared with preoperative study, direct injection of ergonovine made the right coronary artery spastic, but not the left. " 06/01/2004 - "Coronary arteriography and intravascular ultrasound identified a candidate area of minor coronary atheromatous disease but ergonovine provocation testing showed the spastic coronary segment to be distal to and distinct from this area. " 09/01/1988 - "The state of coronary arteries was assessed by means of angiography, and coronary-bed tendency to spastic response was assessed by the ergometrin test in 76 patients with angina of new onset (several days to 2 months since the first symptoms). " 11/01/1986 - "However, in patients with variant angina, a small dose of ergonovine produced a percentage of change in diameter of 39.8 +/- 15.3% at the site of spastic occlusion included by a larger dose of ergonovine, compared with that of 7.0 +/- 11.9% in the remaining non-spastic coronary arteries (p less than 0.05). " 11/01/1986 - "Excluding the site of spastic occlusion produced by the larger dose of ergonovine, diameters of proximal, middle, and distal segments in each major coronary artery were measured before and after a small dose of ergonovine. "

Therapies and Procedures

1.	Injections 01/01/2006 - "BTX-A injections into the salivary glands, in addition to SEMLC, for these 2 children with medically complicated severe spastic quadriplegic CP, were safe and highly successful procedures, which improved their health-related quality of life." 07/01/2007 - "Forty patients (mean age 5 years) with a spastic disorder treated by botulinum injections (53 sessions) were evaluated for functional outcome in terms of achievement of their individual predetermined goals of treatment, rated on a modified Goal Attainment Scale from 1 (worsening function) to 4 (improved gross motor function). " 07/01/2009 - "In this study, BoNT-A injections in spastic upper limbs significantly reduced neurological impairments, but had no functional impact." 01/01/2015 - "It is difficult to make effective injections into all spastic muscles within the officially permitted health insurance dosage of 240 units. " 01/01/2014 - "We presented our experience of BTX-A dosages calculation for the spastic CP treatment which could be used as a recommendation and guide for the multilevel injections treatment according to the aims of rehabilitation, spasticity level, muscle size and motor deficit of a concrete patient."
2.	Rhizotomy 01/01/1987 - "The patients whose function improved most dramatically following rhizotomy were purely spastic and intelligent, were significantly more affected by spasticity in the lower than the upper limbs, had some degree of forward locomotion, and could side-sit independently. " 11/01/2014 - "A beneficial outcome measured by these indicators has been found in our spastic diplegic children one year after rhizotomy." 12/01/1993 - "Preliminary results with follow-up from 1 to 30 months indicates that selective posterior rhizotomy is a safe procedure which contributes to significant functional improvement in spastic patients." 09/01/2004 - "The effect of selective sacral rhizotomy in treating spastic cord injury is significant and worthy of further studies." 08/01/2013 - "Selective dorsal rhizotomy (SDR) is a well-recognized treatment for spastic CP, but little is known about long-term outcomes of this treatment. "
3.	Tenotomy 02/01/2015 - "Compartmental pressure decreased significantly in spastic boys after percutaneous tenotomy of the Achilles tendon. " 04/01/2014 - "Intrinsic lengthening can be used to treat intrinsic muscle spasticity, whereas central slip tenotomy is employed when digital extensor overpull is the deforming force. " 01/01/2001 - "Adductors and flexors tenotomies can correct the spastic hip joint instability fully and permanently if the operation is performed prior to bony changes of the hip. " 01/01/1990 - "Author examined the effect of adductor tenotomies in spastic patients. " 02/01/1981 - "Hip flexor or adductor tenotomies must be considered cautiously for patients with spastic hip extensor muscles, because severe extension constricture may develop after either procedure."
4.	Transcutaneous Electric Nerve Stimulation (TENS) 11/01/2015 - "[Conclusion] TENS application for hemiplegic patients with spastic lower extremities due to cerebrovascular disease resulted in marked improvement in clinical scales of spasticity and significant changes in the electrophysiological variables. " 08/01/2007 - "When compared with the control group, 6 weeks of TENS treatment on the affected lower extremity was more effective in terms of reducing spasticity and improving functional performance in standing, walking, and walking velocity in ambulant children with the spastic CP." 08/01/1985 - "To study the efficacy of electrical stimulation in treating spasticity of six spinal cord injured patients, transcutaneous electrical nerve stimulation (TENS) was applied to the dermatomes belonging to the same spinal cord level as the selected spastic muscle group. " 01/01/2010 - "To study the effect of conventional TENS on spasticity in hip adductors and gait parameters of children with spastic diplegic CP. " 01/01/2010 - "Functional application of TENS to hip adductors of children with spastic diplegic CP can reduce spasticity and improve gait pattern."
5.	Arthrodesis 06/01/2015 - "The role of arthrodesis of the wrist in spastic disorders. " 06/01/2015 - "The role of arthrodesis of the wrist in spastic disorders." 05/01/2012 - "Surgical technique: Medial column arthrodesis in rigid spastic planovalgus feet." 04/01/2012 - "Letter to the editor: Surgical technique: Medial column arthrodesis in rigid spastic planovalgus feet." 01/01/2011 - "Hip arthrodesis is a reasonable option in treating painful spastic subluxated and dislocated hips in CP, primarily in unilateral cases and in patients with ambulatory ability."