A to Z of MS Spasms

Spasm is a potential symptom of multiple sclerosis involving sudden involuntary contractions of muscles. Also known as paroxysmal symptoms, they can be very frightening. Spasms can be painful or cause numbness, but are manageable and treatable.

In MS most spasms occur in:

• legs
• arms
• throat muscles (less common)

Leg and arm spasms are often worsened by bladder and bowel problems and infections, so it is worth investigating other potential causes if spasms start for no reason or become worse suddenly.

Treatment

Leg and arm spasms benefit significantly from physiotherapy and regular stretching.

The following drugs may be used in addition to this:

• Baclofen
• Gabapentin

The NICE Guideline states that the following should only be given if treatment with baclofen or gabapentin is unsuccessful or side effects are unmanageable:

• Tizanidine
• Clonazepam works on the central nervous system. Side effects include reduced attention and memory impairment.
• Diazepam can be used on its own or in combination with other drugs. It can be taken prior to sleep if spasms are particularly troublesome at night. Side effects can include drowsiness and dizziness.
• Dantrolene is the only antispasmodic drug that works directly on the muscles rather than on the central nervous system. It can be used in combination with other drugs. Often it is not well tolerated and can cause nausea, vomiting, diarrhoea and weakness. Regular blood tests need to be completed to ensure no adverse effect on liver function.

• In more severe cases botulinum toxin or intrathecal baclofen therapy may be recommended.

Sativex

Sativex, a cannabis-based mouth spray, is licensed as an add-on treatment for moderate to severe spasticity in people with MS who:

• have not gained adequate relief of symptoms from one or more oral medicines, or have experienced unbearable side effects whilst taking these medicines;

AND

• demonstrate significant improvements in spasticity during an initial trial of Sativex.

Sativex can only be prescribed by a specialist doctor with experience of treating spasticity in multiple sclerosis, for example: consultant neurologists, consultant rehabilitation specialists and consultant pain specialists. A specialist doctor will conduct a full assessment of the severity of spasticity related symptoms and an evaluation of the response to standard spasticity treatments for individuals who might benefit from the use of Sativex.

If people who are prescribed Sativex do not show clear improvement in their spasticity related symptoms during an initial trial of the treatment, then it will be stopped.

Spasms of the throat muscles can cause problems with speech - a sudden bout of slurring, for example - and sometimes with swallowing, often seen as sudden coughing and choking. Treatment may involve a speech and language therapist.

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