Management of Spasticity Revisited

Laura A. Graham


Age Ageing. 2013;42(4):435-441. 

In This Article

Definitions and Epidemiology

It is difficult to define spasticity, as it is not seen in isolation, but occurs as part of a spectrum of symptoms in UMNS diseases. This includes muscle weakness, spasms, clonus and reduced postural responses. The interaction of these components and the complex pathophysiology of muscle tone disturbance are incompletely understood. The ability to distinguish between dynamic elements contributing to muscle stiffness, which are potentially amenable to treatment and those elements have become fixed is clinically challenging. This is reflected in descriptive definitions of the condition.

Lance's 30-year-old landmark definition of 'velocity-dependant intrinsic resistance to passive movement of a limb in people with upper motor neurone syndrome'[1] has been refined by the EU spasm expert group as 'disordered sensorimotor control resulting from an upper motor neurone lesion, presenting as intermittent or sustained involuntary activation of muscles'.[2] This definition takes into account the contribution of visco-elastic properties of soft tissue to limb stiffness (particularly pertinent in older people,[3] as tissue elasticity is lost with age), and the role of proprioceptive and cutaneous neural pathways.

The exact prevalence of spasticity is not known. At least one-third of stroke survivors are affected[4] and one recent study has reported contracture development in 50% 6 months after stroke.[5]