I used to take botulinum toxin. Now I have been using electrostimulation and occupational therapy for over 20 years. Spasticity is weaker than before. Can I get fully rid of the spasticity?

Every therapeutic success—no matter by which method—is welcome. However, it is not yet possible to fully cure spasticity. So far, spasticity is considered irreversible today.

There are many people who benefit from functional electrostimulation (often in conjunction with orthoses, tape or injections) and regular therapy. Overall, there is increasing evidence that a combination of different interventions is more effective in alleviating the symptoms associated with spasticity than an isolated form of treatment.

What happens if I stop treating spasticity? Will my condition worsen quickly?

As a rule, spasticity will worsen when you stop treatment. Muscles and tendons shorten, the joints become stiffer and incorrect posture persists permanently without therapeutic intervention. This leads to an ever-increasing restriction of movement. The declining mobility makes coping with everyday life more difficult, reduces quality of life in general and will increase pain. . According to the International Classification of Function, Disability and Health (ICF) of the World Health Organisation (WHO), most people with spasticity are likely to experience a relevant reduction in their participation in social and professional life if spasticity is not treated. 6

6 CF is the WHO framework for measuring health and disability at both individual and population levels. ICF was officially endorsed by all 191 WHO Member States in the Fifty-fourth World Health Assembly on 22 May 2001(resolution WHA 54.21) as the international standard to describe and measure health and disability.

What factors can worsen my spasticity

The triggering factors for spasticity can vary strongly between individuals. Moods, situations or illnesses might intensify spasticity. 5 These can include:

  • Temperature changes
  • touch
  • tight or uncomfortable clothes
  • physical tension
  • shock, fear
  • fatigue
  • noise of any kind
  • changes of lighting conditions
  • emotional and physical stress
  • sneezing
  • obstipation
  • infection
  • menstrual cycle
  • fever
  • pain
  • thirst, hunger.

5 Phadke CP et. al Revisiting physiologic and psychologic triggers that increase spasticity. Am J Phys Med Rehabil, 2013. 92(4): p. 357-69.

Does the intensity of spasticity depend on the time of day or the weather?

Many patients report that the strength of their spasticity varies with time of day or weather conditions. Low or very warm outside temperatures, storms, sultriness and cold wet weather increase muscle stiffness in many cases.

If the musculature stiffens towards the evening, it might help to postpone or increase the evening medication. Medication should be regularly checked and adapted anyway.

Many patients with spasticity benefit from keeping a regular daily routine. This means, for example, going to bed and getting up at about the same time every day. Muscle complaints often worsen after a short and sleepless night. Regular rest and recovery periods during the day can reduce muscle cramps caused by overload. Patients with spasticity should also pay attention to proper movement and posture patterns. Physiotherapists can give detailed instructions and recommendations.

I’ve been clenching my hand for years. Is there hope for recovery?

It depends. Therapeutic methods such as physiotherapeutic mobilisation, hand orthoses or injections with botulinum toxin and ultimately surgery can be options to reduce spasticity. However, this requires a careful anamnesis and detailed examination. Talk to a physician about treatment options to decide on the right therapy concept for you.

Does spasticity affect cognitive abilities?

No, spasticity doesn’t affect cognitive abilities. The pathological increase in muscle tension is caused by damage of the central nervous system (brain and spinal cord), but it only affects the ability to move.

Are there symptoms/appearances which can be confused with spasticity? Are they treated in the same way as spasticity?

Spasticity is the result of a lesion in the central nervous system (brain and spinal cord). Increase of muscle tones can be caused by other reasons, for example by Parkinson´s disease, due to lack of electrolyte (especially calcium, magnesium, sodium), metabolic disorders and by tetanus.

The treatment of increased muscle tone always depends on its cause. For example, in the case of a Parkinson’s disease dopamine is missing. The result is an increased tension in the extensor and flexor muscles. This type of muscle stiffness is treated with drugs that increase the level of dopamine in the brain.

A lack of electrolytes can lead to prolonged, painful muscle twitching, similar to spasticity. Once missing minerals are replaced, the troubles will disappear.

During metabolic diseases (both congenital or acquired), disturbances in anaerobic and aerobic energy metabolism can lead to muscle cramps. The therapeutic goal is to normalize the metabolism.

Tetanus has become rare due to existing vaccinations. These are important because in most cases the infectious disease is fatal. The toxins of the tetanus-triggering bacterium Clostridium tetani attack the muscle-controlling nerve cells and cause severe muscle cramps. There is no real causal treatment so far. The best prevention is immunisation with a tetanus vaccine.

Can spasticity heal by itself?

Spasticity cannot heal by itself or disappear without treatment. The symptoms and complications are likely to worsen without therapeutic intervention.

Will spasticity keep me from walking?

Depending on brain and spinal cord damage, spasticity can cause limited mobility of the lower extremities and difficulties in walking. Since each individual is unique, this can only be answered by a doctor on the base of symptoms and findings.