Spasticity is a condition that frequently develops after injury to the brain or the spinal cord such as occurs with stroke, brain tumors or head trauma and spinal cord bruising or tearing during a traumatic event, surgery or tumor growth; other disabling neurological disease such as multiple sclerosis and cerebral palsy can also result in spasticity. Muscles can develop stiffness and become difficult to move. The severity can be high enough that the muscles are rigid and can jerk in spasms when trying to move them. The degree of spasticity will determine the degree of functional impairment. If left untreated, muscles and the attached soft tissues can become contracted. Worsening spasticity can degrade the quality of life of a patient and their caregivers. There are good clinical, humanistic, and economic reasons to treat spasticity.
Diagnosis of Spasticity
The history of the condition will reveal the inciting injury or the likely underlying neurological disease that leads to the development of spasticity. The physical examination will reveal the degree of muscle overactivity and degree of motion present. Neurological testing reflexes are abnormal to a degree and can be easily assessed during the examination. PCI will often work with a physical medicine doctor or therapist to help assess the degree of spasticity for measurement purposes.
Treatment of Spasticity
Initial treatments may vary for specific types of spasticity. Those initial treatments may include oral muscle relaxants and botulinum injections into muscle groups. When the initial treatments fail and the spasticity is widespread then baclofen, a potent muscle relaxant medication, delivered directly to the spinal cord via an implanted pump may be considered. The procedure for doing this is two staged. The first stage is to inject baclofen directly into the fluid surrounding the spinal cord via a spinal tap needle. If muscle spasm and overactive tone improve significantly, then the second stage of implanting a permanent programmable and refillable pump is performed in a minor outpatient surgery. During the surgery, a thin catheter or tube is placed via a needle into the column of fluid which surround the spinal cord and is tunneled under the skin to a pump that is placed in a pocket created under the skin. Pump refills are done about every 2-3 months so that fresh drug is always available in the pump. Adjustment in the pump drug delivery settings are done to ease the spasticity and avoid side effects of the medication. PCI providers are experts at patient evaluation, staged trials of baclofen, pump implantation, and pump management/refilling.