Spasticity is the excessive contraction, stiffening, and involuntary spasms of muscles, ranging from mild stiffness to severe, uncontrollable convulsions.

What is Spasticity?

Derived from the Greek word spasticus (to pull), spasticity is the excessive contraction, stiffening, and formation of involuntary spasms in muscles. Spasticity has a wide range, from mild stiffness to severely uncontrollable convulsions. The problem of muscle contractions is generally caused by neural damage in the areas of the brain or spinal cord that control muscle movements. Among the triggering causes are diseases such as spinal cord injury, multiple sclerosis, and cerebral palsy.

What Are the Symptoms of Spasticity?

The symptoms of spasticity include:

• Hypertonia (increased muscle tone)
• Clonus (rapid muscle contractions)
• Exaggerated deep tendon reflexes
• Muscle spasms
• Involuntary crossing of legs
• Fixed joints (contractures)
• Persistent muscle stiffness and spasms
• Pain or discomfort
• Reduced functional ability
• Care and hygiene difficulties
• Abnormal posture

Bone and joint deformities may develop, and the degree of spasticity can range from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms. In children, spasticity can cause growth problems, painful and deformed joints, and disability.

What Are the Causes of Spasticity?

Spasticity is a symptom associated with damage to the brain, spinal cord, or motor nerves. Spasticity can occur as a result of the following conditions:

• Cerebral palsy (CP)
• Multiple sclerosis (MS)
• Stroke
• Traumatic brain or spinal cord injury
• Amyotrophic lateral sclerosis (ALS)
• Hereditary spastic paraplegias
• Adrenoleukodystrophy (ALD)

Spasticity can be seen as a result of many diseases affecting the brain and/or spinal cord.

How is Spasticity Diagnosed?

Spasticity, which can occur congenitally or later in children, can also be seen in adults. The basis of spasticity diagnosis is revealed through neurological examination and evaluation. The diagnosis is made based on the history of the disease, physical examination results, and information obtained from nervous system imaging methods. During the physical examination by a specialist doctor, sitting, standing, walking, body posture, deep tendon reflexes, and muscle tension are evaluated.

How is Spasticity Treated?

The key point in spasticity treatment is deciding whether the spasticity should be treated, and if so, forming the treatment team. Spasticity treatment should be applied as an individual program for each patient. Treatment is generally divided into three categories: physical therapy, medication, and surgical treatment.

Baclofen Pump

The baclofen pump, commonly used in the treatment of spinal cord-related spasticity and referred to as a muscle relaxant drug, has a suppressive effect on brain and spinal cord reflexes. It exerts its effect by crossing the blood-brain barrier. Since it can cross the blood-brain barrier only in very small amounts after oral use, requiring higher doses with increasing risk of side effects, intrathecal baclofen applications are used as an important and highly effective treatment alternative for patients with uncontrollable spasms.

When intrathecal administration is planned for patients with spinal cord-related spasticity who use oral baclofen but experience side effects or insufficient drug response, a specific pathway should be followed. The drug is first administered in a certain amount into the spinal canal. The effect of the drug on spasticity is evaluated. If sufficient relaxation does not occur, the test is repeated with an increased drug dose. The evaluation is performed by neurology, physical therapy, and neurosurgery specialists. If the patient benefits from this test, a permanent baclofen pump is implanted.

Baclofen Pump Implantation

It is a procedure performed under general anesthesia. The system consists of a pump and a catheter. The catheter is placed in the area beneath the membrane called the 'dura mater' that surrounds the spinal cord, where the fluid called CSF is located. The pump is placed subcutaneously on the lateral side of the abdomen. Medication is administered into the pump. The pump, which can be adjusted externally, is operated by setting the desired medication dose. It contains baclofen sufficient for approximately 6 months. When it runs out, refilling is done easily.