Neurology The role of spasTiciTy in The qualiTy of life of people wiTh Ms – a reflecTion Nicola Russell – Director of Services MS Trust
Definition and language can be a real and social activities. A clinical algorithm
and challenging condition for the barrier to treating spasticity correctly. describes the management of an increase individual given the diagnosis as The person with MS might describe their in spasticity including the usage of
well as for the health professionals and symptom as a 'spasm', using the term to potential treatments. Table 2 shows the health care systems trying to maximise their mean a sudden wave of pain, whereas possible trigger factors for spasticity. health and quality of life. Not only is there a health professional would understand Effective treatments include physiotherapy, a loss of mobility and function brought on the word to mean a sharp contraction of occupational therapy, rehabilitation as well by the disease but there are also a range a muscle. People with spasticity will also as drug therapies. Within drug therapies of symptoms which can be seen to varying describe their muscles as feeling stiff, degrees. Currently there are approximately heavy and difficult to move. Table 1 shows 100,000 people with MS in the UK and it the different types of spasms people with remains the greatest cause of disability in MS can experience. The management of spasticity can be a rewarding challenge
One of the most challenging symptoms vary from person to person, day to day,
for health care professionals in both hospital and community
of MS is spasticity. The impact on a person's hour to hour and can impact on many
settings. Tailoring treatment
life and ultimately that of their family and activities. Nevertheless, spasticity can be
strategies to suit an individual
carers can be far-reaching. It affects all successfully managed. Education of and
requires detailed ongoing
aspects of life; employment, home and commitment by the person with spasticity,
liaison between the person
social and it changes relationships when multidisciplinary teamwork and the
with spasticity, carers and their treating teams.
family and friends are insidiously drawn appropriate timing and use of various drug into a caring role. Spasticity affects how treatments can maximise management. people see themselves and how they
believe others see them and can lead health professionals to summarise the to frustration, and depression, further management of spasticity in a care the NICE Guideline2 states that the first affecting lifestyle.
pathway. Written by Dr Val Stephenson line of treatment should be baclofen or
Research undertaken in 2004 showed a consultant neurologist at the National gabapentin. Other drugs should only be
that 82% of people with MS experienced Hospital for Neurology and Neurosurgery, given if treatment with baclofen or the a problem with spasticity with 54% and specialist nurses Liz Keenan and Louise anti epileptic gabapentin is unsuccessful classifying the impact as "moderate" Jarrett it explores the various issues related or side effects are unmanageable. Baclofen or "high"1. People can describe the to spasticity including the prevention of acts directly on the central nervous system spasticity as annoying, uncomfortable and sensory stimuli, the importance of posture, and the dose must be titrated to ensure unpredictable, although spasticity can also and effective moving and handling. It maximum efficacy without undue side be helpful. For example some people use considers the impact of spasticity for effects. Tizanidine also acts on the central the stiffness of their spasticity or extensor the person with MS in particular pain, nervous system and requires titration. spasms to assist them when walking or sexual dysfunction, emotional issues and Benzodiazepines such as Diazepam or transferring from bed to chair.
the impact of spasticity on employment Clonazepam may be valuable especially
prior to sleep. Dantrolene is the only drug
Trigger factors Management advice
used that acts directly on the muscles. More serious treatments include intrathecal baclofen administered via an implanted pump. Phenol injected into the intrathecal
Review of bladder, bowel and skin care management techniques may improve the
severing of the tracts in the spinal cord.
Pain and infection will aggravate spasticity.
Locating and treating the source of the pain
side effects intolerable. The clinical trial
or infection eg skin infection or an ingrown
Figure 1 to be positioned in column 1 page 2 starting below small block of text.
Simply loosening tight garments may help to relieve spasticity. If splints are causing discomfort or skin irritation then they will need reviewing by an orthotic or therapy service. Flexor spasms:
The limb will bend upwards towards the person's body
is interesting and shows the difficulties their spasticity effectively to improve their of carrying out studies in a complex quality of life, help them remain mobile, in variable long term condition such as MS. work and self managing. n Effective measures of spasticity are not readily available and in addition what For a free copy of:
the person with MS values in the context l "The role of the healthcare Extensor spasms:
of their daily life is often not perceived
professional in the management of
The limb extends away from the person's body
spasticity" care pathway
The early Plymouth study undertaken to l Spasticity and spasms factsheet look at the effect of cannabis therapy on spasticity was not statistically significant MS Trust www.mstrust.org.uk using the Ashworth scale to measure the Phone: 01462 476700 spasticity and yet all the people with MS quality measures were positive3. How to
balance these issues remains a challenge ReFeReNceS Adductor spasms:
for licensing and funding authorities. 1. Hemmett L, Holmes J, Barnes M, Russell
The limb will pull inwards towards the person's body.
Commonly a person experiences this as difficultly
N. What drives quality of life in multiple
are closer to their patients and see the
consequences of their illness the decisions 2. National Institute for Clinical Excel-may be more straightforward, and the
long awaited arrival of a licensed cannabis
secondary care. NICE Clinical Guideline 8.
Effective spasticity management requires 3. Zajicek J, Fox P, Sanders H, Wright D,
Spasms affecting the trunk:
of trigger factors and the careful evaluation
The back or trunk can arch off a bed or away from the
and use of drug treatments. Primary care
clinicians are well placed to anticipate
MATERIAL SAFETY DATA SHEET C0348-C0180-UK 1. Identification of the product and the company : TRIPTAM. Chemical description active ingredient(s) : Tetramethylthiuram disulfide; Bis(dimethylthiocarbamoyl) disulfide. 1B Mills WayBoscombe Down Business ParkAmesbury Wiltshire SP4 7RX United KingdomTel. +44 (0) 1980 676500 Fax +44 (0) 1980 626555E-mail: firstname.lastname@example.org: For adv
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