Featuring Barry A. Hendin, MD 

MSAA’s Chief Medical Officer  

Question: Does spasticity in MS ever improve on its own and what are the best treatments for this symptom? 

Answer: First, it may help to define spasticity in simple terms. Spasticity is an increase in muscle tone due to an imbalance between excitatory and inhibitory influences on nerve flow along the motor pathways of the brain and spinal cord. Symptoms can vary from mild discomfort to severe pain and disability. Activities of daily living, quality of life, upper extremity function, and gait, can all be affected. 

As with all MS symptomatology, spasticity can vary in intensity. It can improve or worsen, depending upon MS relapses, progression, or outside influences – including events, such as urinary tract infections. Fortunately, many interventions can help to reduce spasticity and improve comfort and function. 

Home-based interventions, such as stretching and exercise, plus relaxation techniques, can be helpful and self-directed. These interventions can be augmented by formal physical therapy and occupational therapy. Also, prescribed medications as well as approved complementary and alternative medicine (CAM) therapies are often employed and provide benefits.  

Some commonly prescribed medications are baclofen, tizanidine (Zanaflex^®), clonidine, dantrolene (Dantrium^®), benzodiazepines, and gabapentin (Neurontin^®). Botulinum toxin injections (Botox^®) are often used to reduce muscle tone. In severe cases, surgical interventions can be considered, and these may include baclofen pumps or dorsal rhizotomy (a surgical procedure where specific nerve fibers are cut to permanently relieve spasticity in certain areas).  

In addition, many people find CAM therapies, such as relaxation techniques (which can include deep breathing and guided imagery) to be effective in reducing spasticity. Acupuncture, cooling devices, and cold packs can be of help as well. Many also find aquatic therapy or aquatic exercise to be effective in reducing spasticity. Cannabinoids (medical marijuana) may be helpful for some individuals, although they have not yet been fully investigated or FDA-approved in all areas.  

So, to the question of whether spasticity can improve, the answer is yes… sometimes spontaneously, but more often improvement results from proven therapies and interventions. 

MSAA’s Ask the Expert series received a Silver Award from the 24th Annual Digital Health Awards! 

Barry A. Hendin, MD, is a neurologist and Director of the Arizona Integrated Neurology MS Center. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School.