Spasticity and Muscle Spasms in Multiple Sclerosis

Involuntary muscle spasms and muscle stiffness are very frequent symptoms of Multiple Sclerosis. They are not usually among the initial symptoms that people experience when the disease first affects them. But eventually as the M.S. disease course progresses, muscle spasms will be experienced by 60-90% of patients. The severity of the symptoms can range from very mild to quite severe, greatly compromising the person’s life impacting: Body Movements/Physical Abilities with everyday tasks, Walking, Vocational Duties, Social Functioning, and quality of Sleep/Rest Periods.   

Myelin is an insulating layer, or sheath, around nerves cells, including those in the brain and spinal cord. Myelin is destroyed by the M.S. disease process. This is what prevents the nerve cells from communicating properly with the muscle cells (muscle fibers), with the spinal cord, and the brain.  The electrical impulses that move along the nerve cells and nerve tracts are slowed down or stopped on their way to the muscles they supply. Disrupted impulse conduction along the neural pathways can also cause over activity of the muscles, as well as the loss of coordination.

Skeletal muscles function to move the joints in our bodies. Joints can flex (bend) or extend (straighten out) so there can be flexor spasms or extensor spasms. A spasm that causes an arm or leg to be pulled toward the body is an adductor spasm. A spasm that causes a limb to be pulled away from the body is an abductor spasm. Spasms can also affect the trunk or torso of the body. Each of these spasms will have a different effect on attempted activities and motor functioning. Pain with muscle spasms can range from dull aches to deep, sharp, acute pain.

Spasticity causes a person’s muscles to feel stiff, heavy, rigid and difficult to move. It is the result of an increase in muscle tone—tonic stretch reflexes. “Spasticity-plus syndrome”1, 2 is a concept that has been developed to describe the constellation of different symptoms that accompany muscle spasms and augment the problems experienced with spasticity and spasms. Besides mobility, many other bodily functions and systems are affected by this syndrome: e.g., sleep disorders, fatigue, bowel, bladder, sexual, persistent, or sudden/intermittent pain, as well as other functions and abilities.

For me, the muscle spasms occur in my legs when I am lying in bed at night trying to sleep. It usually involves just one leg at a time, not both legs on the same night. These muscle spasms occur repeatedly at times, like a drummer beating on a drum. This rhythmic muscle action motion is called Clonus. Or it can occur as a single gradual squeezing of the muscle that slowly worsens as the contraction increases. It can be mild, but for me, is most often a strong, involuntary muscle contraction that causes hip flexion, knee flexion, ankle flexion or toe extension. It happens suddenly and abruptly. At times the muscle contraction is like a severe “Charlie horse” which is so painful, I have to jump out of bed and massage that muscle, stomp on the floor, move my joints through range of motion, and other actions to relieve it. This is typical for many other people with MS.  

Factors that Trigger spasticity or spasms: infection in an area of the body affecting movement like an ingrown toenail, body temperature being too hot or too cold, tight-fitting clothes in area near body movement, bowel or bladder problems, and other things related to positioning or activity, muscle or total body fatigue.

Treatment of spasticity should be multidisciplinary to address the wide variety of symptoms and problems a person may experience.

Medications: There are plenty of over-the-counter (OTC) products that provide some relief, some of the time, for some people. You just need to try different ones till you find one that works for your symptoms.

There are a number of prescription oral medications to address spasms and spasticity (e.g., baclofen, tizanidine, dantrolene, gabapentin, diazepam, clonazepam, pregabalin). Sometimes an invasive therapy may be used to deliver baclofen into the small space surrounding the spinal cord (intrathecal space) through a catheter connected to a small pump placed in the abdomen. More recently the use of cannabinoids have been tested and used for spasticity symptoms, with some effectiveness. There are cannabinoid receptors (CB1 and CB2) in the central nervous system.   

Botox (Botulinum toxin) injections are used to relax and temporarily weaken involved muscles, preventing them from contracting strongly. This mode of treatment usually lasts 3 to 6 months. I have gotten Botox injections for my lower leg muscles, toe extensors, and thigh muscles too. I experienced relief for over 3 years. But my nighttime muscle spasms are returning and getting worse, so I will schedule more Botox injections.

Therapy: Aquatic exercise in warm (not hot!) water is very helpful with reducing spasticity because the thermal energy of the water is transferred quickly and effectively to the muscles, helps relax the muscles, and the buoyancy of aquatic environment takes weight of the body off the joints. All these benefits assist with moving the body in different directions with various exercises while in the water.

Other helpful physical therapy modalities include passive and active exercises focusing on stretching and range of motion, strength, and flexibility. A physical therapist provides consultation to develop a person’s exercise plan, advice on posture, ways to improve balance, improve gait with or without gait aids, prevent joint contractures and other complications related to lack of exercise and mobility.

Occupational therapists can also advise you on posture. They help you find ways to make day-to-day tasks easier. Occupational therapy can assist you with upper extremity dexterity exercises, seating positions and adapted seating, aids to improve seating posture, sleeping positions, and safe use of wheelchairs.

While spasticity and muscle spasms are common problems for people with M.S., more research and innovation in this area is providing additional and more effective ways to minimize these problems and improve the quality of life for people with M.S.

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1 The Broad concept of “Spasticity-Plus Syndrome” in multiple sclerosis: A possible new concept in the management of multiple sclerosis symptoms. Fernandez, O., Costa-Frossard, L., Martinez-Gines, M. Montero, P., Prieto, J., Ramio, L. Frontiers in Neurology, Vol. 11, March, 2020.

Defining the spectrum of spasticity-associated involuntary movements. Hesham, A., Gabrielle, M., Xin Xin, Y., Konrad, K., Hubert, F., François, B., Parkinsonism and Related Disorders, Vol 65, August 2019, 79-85. https://doi.org/10.1016/j.parkreldis.2019.05.007

2 Integrated management of multiple sclerosis spasticity and associated symptoms using the spasticity-plus syndrome concept: Results of a structured specialists’ discussion using the Workmat® methodology. Fernandez, O., Costa-Frossard, L., Martinez-Gines, M. Montero, P., Prieto-Gonzalez, J., Ramio-Torrenta, L. Frontiers in Neurology, Vol. 12, September 2021.

Multiple sclerosis and spasticity. Sherrell, Z. Medical News Today, November 30, 2021.

https://www.medicalnewstoday.com/articles/multiple-sclerosis-spasticity-causes-and-management

Spasticity in multiple sclerosis and role of glatiramer acetate treatment. Meca-Lallana, J.E., Hernandez-Clares, R., Carreon-Guarnizo, E. Brain and Behavior, 2015; 5(9).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589813/

Spasticity in multiple sclerosis: Contribution of inflammation, autoimmune mediated neuronal damage, and therapeutic interventions. Patejdl, R., Zettl, U. Autoimmunity Reviews. Vol 16:9, September 2017, 925-936. https://doi.org/10.1016/j.autrev.2017.07.004

Spasticity Triggers Booklet. Lough, J. and Cowan, P. Multiple Sclerosis Trust, (30).

https://mstrust.org.uk/a-z/spasticity-and-spasms