Decreasing Spasticity After a Stroke

Since spasticity is a protective mechanism initiated by the spinal cord, in response to a lack of brain signals to that muscle (see my article “What is Spasticity?” for more info), the only true way to decrease spasticity is to INCREASE the brain’s control of that muscle.  This is done by neuroplasticity, using repetitive exercise (physical and mental) to re-wire the neural circuits of your brain.

There are ways to decrease spasticity through medications.  However, some of these methods have side effects, or are only temporarily effective.  For example,  the oral medications baclofen, tizanidine, valium, dantrium, and clonazepam have shown only minimal improvements in spasticity while being taken, and haven’t shown any improvements in overall function (1).  Some also carry possible side effects for liver function, dizziness, nausea, weakness, and/or sleepiness.  This last side effect (sleepiness) is one way in which these medications might be valuable….for improving sleep in someone who has difficulty sleeping due to muscle spasms.  Often several of these different medications are given together, in very low doses, in an attempt to minimize the collective side effects.

One medication called Baclofen can be administered intrathecally.  This is called Intrathecal baclofen therapy (ITB), and involves injection directly into an area of the spinal cord.  Only a very small amount of the drug is required, so it doesn’t carry the side effects of oral administration of this drug.  It has been shown to be effective, and generally can be considered as early as three to six month’s after a stroke. (2)

Another option is commonly called a nerve block.  Injecting phenol or alcohol directly into the site of spasticity causes injury to the nerve fibers of that specific muscle, as well a localized anesthesia.  It causes almost immediate relaxation, and can last up to a year or longer (1).  However, there are possible side effects if the alcohol or phenol is absorbed into the circulation.

A more easily administered medication than the nerve block is Botulinum Toxin (or Botox….yes, the same drug that movie stars use to get rid of their wrinkles).  Injection of this molecule directly into the spastic muscle causes decreased spasticity for up to 3-4 months.(3)   It tends to be used more than alcohol or phenol injections, and comes in different forms.  Botox A, or Botox B (which is marketed as Myobloc in the United States, or Neurobloc elsewhere).

• But remember, this is NOT a permanent cure!  This time of decreased spasticity should be used as a window of opportunity to increase your brain’s control over that arm or leg……through neurplasticity, which offers the only way to permanently decrease spasticity.

Finally, as a last resort, surgical intervention is sometimes used to release, or lengthen certain tendons of the spastic muscles, thereby improving joint mobility.