Management of Spasticity in Multiple Sclerosis

Spasticity is a common and often disabling feature of multiple sclerosis, characterised by involuntary muscle stiffness and spasms that impair mobility, function and quality of life. Management encompasses a spectrum of approaches, beginning with first-line oral medications such as baclofen, tizanidine and benzodiazepines to reduce neural hyperexcitability. For refractory or severe cases, invasive options include intrathecal drug delivery systems and targeted corticosteroid injections. Advances in cannabinoid-based therapies have introduced novel symptomatic relief by modulating central nervous system receptors, while physiotherapy and self-management strategies—such as supported standing programmes—aim to preserve motor function and prevent secondary complications. Emerging frameworks promote integrated care, recognising clusters of spasticity-related symptoms and encouraging interprofessional collaboration to individualise treatment, minimise polypharmacy and optimise long-term outcomes.

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Management of Spasticity in Multiple Sclerosis publication trend

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Technical terms

Spasticity: A condition of increased muscle tone and exaggerated stretch reflexes resulting from central nervous system lesions.

Intrathecal injection: Delivery of medication directly into the cerebrospinal fluid in the spinal canal.

Nabiximols: An oromucosal spray combining tetrahydrocannabinol and cannabidiol for symptomatic relief of spasticity.

Standing frame: A supportive device enabling individuals with impaired mobility to stand upright and perform weight-bearing exercises at home.

References

1. The Broad Concept of “Spasticity-Plus Syndrome” in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms. Frontiers in Neurology (2020).
2. Assessment of a home-based standing frame programme in people with progressive multiple sclerosis (SUMS): a pragmatic, multi-centre, randomised, controlled trial and cost-effectiveness analysis. The Lancet Neurology (2019).
3. 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. Frontiers in Neurology (2021).
4. Systemic Effects by Intrathecal Administration of Triamcinolone Acetonide in Patients With Multiple Sclerosis. Frontiers in Endocrinology (2020).
5. Efficacy of repeated intrathecal triamcinolone acetonide application in progressive multiple sclerosis patients with spinal symptoms. BMC Neurology (2004).