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:

Spastic; Clasp Knife Spasticity; Spasticity, Clasp-Knife; Spasticity, Muscle; Clasp-Knife Spasticity

Networked: 3127 relevant articles (269 outcomes, 405 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.	Paralysis (Palsy)

Experts

1.	Picelli, Alessandro: 22 articles (03/2022 - 05/2012)
2.	Smania, Nicola: 20 articles (03/2022 - 05/2012)
3.	Santamato, Andrea: 14 articles (03/2022 - 10/2010)
4.	Deltombe, Thierry: 14 articles (01/2021 - 01/2004)
5.	Gracies, Jean-Michel: 13 articles (01/2021 - 03/2004)
6.	Yasue, H: 12 articles (09/2001 - 01/2000)
7.	Baricich, Alessio: 11 articles (03/2022 - 11/2008)
8.	Park, Eun Sook: 11 articles (01/2020 - 11/2002)
9.	Kugiyama, K: 11 articles (09/2001 - 01/2000)
10.	Ogawa, H: 11 articles (09/2001 - 01/2000)

Drugs and Biologics

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

1.	Type A Botulinum Toxins (Botox)FDA Link 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. " 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." 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." 07/01/2019 - "Conclusion: Our study strengthens the observation that botox treatment of the spastic calf muscle together with plaster casting can result in improved ankle dorsiflexion. " 09/01/2020 - "These results may help improve the efficiency and efficacy of botulinum toxin A injection in the treatment of medial femoral muscle spasticity."
2.	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. " 05/15/2005 - "Variability and predictability of functional efficacy of botulinum toxin injection in leg spastic muscles." 02/01/2013 - "This study showed that botulinum toxin injection in the spastic rectus femoris of hemiparetic patients improves muscle kinematics during gait. " 04/01/2006 - "This study reports the effects and side effects of botulinum toxin treatment on upper limb impairment and function in 18 children with spastic or dystonic hyperactivity. " 01/01/2006 - "Low-dose botulinum toxin with short-term electrical stimulation in poststroke spastic drop foot: a preliminary study."
3.	incobotulinumtoxinA FDA Link 07/01/2019 - "This randomized single-blind pilot study aimed to investigate the efficacy of ES of antagonist muscles as adjunct treatment after BoNT-A injection to plantar flexor muscles in hemiplegic patients with spastic equinus foot. " 03/12/2016 - "It indicates both neural and non-neural components of the spastic gastrocnemius muscles improved at four weeks after BoNT-A injection in children with CP. " 01/01/2014 - "A meaningful improvement in walking performance can be obtained in chronic spastic patients after BoNT-A injection into several muscles, specifically the hip adductors." 10/01/2020 - "Twenty-four pediatric patients diagnosed with a spastic type of CP, who were scheduled to receive a BoNT-A injection in the gastrocnemius muscle, were included in the study. " 01/01/2020 - "The aim of this study was to investigate the relation between the types of stretch reflex muscle activation in the semitendinosus with post-BoNT-A outcome as assessed passively and with 3D gait analysis in children with spastic CP. "
4.	Baclofen FDA 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." 01/01/1996 - "Baclofen suppressed spastic signs in 10 patients: it eliminated clonus and decreased the co-contraction of antagonist and distant muscle groups. " 04/01/2000 - "Fourteen spastic MS patients were examined in a placebo controlled double-blind, cross-over trial of oral baclofen treatment. " 03/01/2000 - "The present study shows that the antispastic effect of intrathecally administered baclofen in spastic patients can be quantitatively assessed by a sensitive method allowing measurement of elastic and viscous components of muscle stiffness."
5.	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. " 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. " 01/01/2014 - "We investigated the effects of a pharmacological (an anti-spastic medication - tizanidine) and a physical intervention (robotic-assisted locomotor training - Lokomat) on function in people with incomplete SCI over 4-week of training. "
6.	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. " 02/01/2018 - "The chest pain was likely caused by coronary spastic angina, which was treated with diltiazem hydrochloride." 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."
7.	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. " 03/01/2010 - "We compared the efficacy of once-daily treatment with nifedipine CR 40 mg (NR) and twice-daily treatment with benidipine 4 mg (BD) in patients with coronary spastic angina (CSA) registered in 3 cardiovascular institutes in Tokyo. "
8.	Calcium Channel Blockers (Blockers, Calcium Channel)IBA 04/01/2009 - "Differential effects of calcium-channel blockers on vascular endothelial function in patients with coronary spastic angina." 03/01/2009 - "High incidence of repeat anginal attacks despite treatment with calcium-channel blockers in patients with coronary spastic angina." 03/01/2008 - "Calcium channel blockers have proven a benefit but their vasodilating effect on spastic cerebral arteries is relatively modest. " 01/01/2000 - "The radial artery is spastic, and calcium channel antagonists have been used clinically in the radial artery for their antispastic effects. " 05/01/2020 - "Calcium channel blockers may be effective for coronary spastic angina and allow patients to continue multiple myeloma treatment.>."
9.	abobotulinumtoxinA FDA Link 11/28/2017 - "Efficacy and safety of abobotulinumtoxinA in spastic lower limb: Randomized trial and extension." 01/01/2021 - "To assess changes in walking velocity (WV), step length, and cadence under different test conditions after repeated treatment with abobotulinumtoxinA (aboBoNT-A; Dysport) in spastic lower limb muscles. " 01/01/2020 - "A retrospective analysis of injection protocols of Abobotulinum toxin A for 99 patients with bilateral spastic CP GMFCS III at the age of 2 to 12 years was performed. " 12/01/2016 - "Participants were randomly assigned to two groups: patients allocated to the group 1 received robot‑assisted gait training (30 minutes a day for five consecutive days) after AbobotulinumtoxinA injection into the spastic calf muscles as well as patients allocated to the group 2 were only injected with AbobotulinumtoxinA into the same muscles. " 01/01/2020 - "AbobotulinumtoxinA (aboBoNT-A, Dysport®) is used in clinical practice as a well-tolerated and effective therapy for muscle spasticity. "
10.	Acetylcholine (Acetylcholine Chloride)FDA Link 06/01/2008 - "Since we know that only active synapses binds BTA (receptor is located in the acetylcholine vesicle) further therapeutic methods should also be employed to enhance efficacy of BTA, especially casting and splinting electrical stimulation, for muscle activation and regaining of normal length of spastic muscules are recommended. " 01/01/2020 - "This study examined whether there are differences in nitroglycerine-mediated dilation (NMD) and flow-mediated dilation (FMD) response between wildALDH21/1and variantALDH2*2patients with CAD.Methods and Results:The study subjects comprised 55 coronary spastic angina (CSA) patients, confirmed by coronary angiography and intracoronary injection of acetylcholine (42 men and 13 women, mean age 68.0±9.0 years). " 06/01/2011 - "We diagnosed coronary spastic angina after acetylcholine challenge test. " 05/01/2003 - "Self-vasodilating ability at the spastic site of patients with vasospastic angina: estimation by acetylcholine delayed phase." 01/01/2001 - "The responses of epicardial diameter of the left coronary arteries to intracoronary infusion of acetylcholine (ACh; 50 microg/min) were measured by quantitative coronary angiography before and during combined intracoronary infusion of GSH (50 mg/min for 6 min) or saline as a placebo in 24 patients with coronary spastic angina and in 28 control patients. "

Therapies and Procedures

1.	Therapeutics 10/27/2023 - "The likeliness for this intervention to be successful as a noninvasive anti-spastic therapy after SCI is suggested by a mild and transitory improvement in spastic symptoms following a single stimulation session, but it remains to be determined if repeated tSCS over the course of weeks can produce more profound effects. " 09/11/2023 - "We expressed the cost-effectiveness of RAGT in the Lokomat® system after analysing the costs and effects of RAGT and conventional therapy through the Incremental Cost-Effectiveness Ratio (ICER) based on a bicentric randomized controlled study, in which we demonstrated that the intensive RAGT regimen is more effective than conventional therapy in terms of improvements in gross motor functions in adolescent and adult patients with bilateral spastic CP. " 09/11/2023 - "However, from the comprehensive analysis of the results and evaluation of the long-term effects, it follows that RAGT applied in adolescent and adult patients with bilateral spastic CP is not only more effective in terms of evaluation of monitored clinical parameters, but in the long term it is also more cost-effective compared to conventional therapy." 01/01/2020 - "We demonstrated that the intensive RAGT regimen is more effective than conventional therapy in terms of improvements in gross motor functions in adolescent and adult patients with bilateral spastic CP." 03/01/2017 - "Our overall results showed that RTHE, operativized throughout MEMSs, could be an objective gold standard to evaluate MS muscle spasticity as well as the effectiveness of antispasticity therapy."
2.	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). " 01/01/2020 - "The results of this study provide evidence that BoNT injections can reduce spasticity and muscle strength, while motor performance of the weakened spastic muscle remains unchanged." 01/01/2021 - "Medications, injections, and tendon surgeries had failed to relieve her spastic lower extremities. " 10/07/2020 - "Participants received BoNT injections for their spastic elbow flexors under ultrasound guid-ance. "
3.	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." 01/01/2020 - "Our modified rhizotomy protocol is feasible, safe, and effective to guide SL-SDR to treat all types of spastic CP cases by decreasing muscle tone in particular spastic muscle groups in their lower limbs. " 09/01/2004 - "The effect of selective sacral rhizotomy in treating spastic cord injury is significant and worthy of further studies."
4.	Physical Therapy Modalities (Physical Therapy Technique) 08/01/2007 - "This study included 42 children of both sexes, aged 2-6 years, with spastic CP, divided into two groups: group I (21 child) treated with BTA and physical therapy, and group II (21 child) treated with physical therapy only. " 08/01/2005 - "A total of 16 patients (11 males [68.75%] and five females [31.25%]), diagnosed as spastic diplegic and referred to the School of Physical Therapy and Rehabilitation, Paediatric Rehabilitation Unit for treatment, were included in this study. " 01/01/2021 - "Kinesio-taping may be an effective adjunct to conventional physical therapy in improving sitting ability in children with spastic bilateral CP. " 12/01/2018 - "Ten children with spastic CP were randomly assigned to a general physiotherapy group (trunk strengthening exercise and gait training) (n=5) and a Vojta approach group (n=5). " 08/01/2014 - "Associated with physical therapy, BT allows optimal management of spastic children."
5.	Myotomy 01/01/2020 - "While it is well known that POEM is a safe and effective treatment for spastic esophageal disorders, we conclude that variation in total myotomy length and prior endoscopic or medical treatments did not have a significant effect on clinical success." 08/01/2002 - "Thoracoscopic long myotomy offers effective relief for spastic disorders of the esophagus. " 01/01/2019 - "However, evidence is lacking that efficacy is improved by tailoring myotomy to the length of the spastic segment on HREM. " 06/01/2023 - "It is based on the principle to open spastic aganglionic bowel segments by performing a myotomy through a submucosal tunnel. " 01/01/2023 - "This allows the performance of submucosal tunneling and myotomy for spastic segments of the gastrointestinal tract. "