MANAGEMENT OF SPASTICITY IN MULTIPLE SCLEROSIS: A CONSENSUS STATEMENT OF THE HELLENIC NEUROLOGICAL SOCIETY, THE HELLENIC ACADEMY OF NEUROIMMUNOLOGY AND THE HELLENIC SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE

Abstract

Spasticity is a sensorimotor phenomenon characterized by velocity dependent hypertonia, involuntary muscle
spasms or contractions, and is a common cause of disability and quality of life (QoL) impairment in multiple
sclerosis (MS). Epidemiological evidence points towards a very high prevalence of MS-related spasticity
(MSS) of up to 80% among MS patients. MSS is characterized by a wide spectrum of clinical manifestations
and related complications, that contribute to worsening of motor deficits and loss of independence of MS
patients, while if left without prompt treatment, MSS may lead to permanent joint deformities, muscle
contractions, pain, involuntary movements, and skin complications. The diagnosis and clinical follow-up of
MSS requires implementation of well-established clinical scales (Ashworth Scale, modified Ashworth scale,
Tardieu Scale), but also requires use of functional scales that incorporate patient-relevant outcomes. The
management of MSS should be initiated by multidisciplinary teams consisting of Neurologists and Physical
Medicine and Rehabilitation (PM&R) physicians. Therapeutic goals include the overall clinical and functional
improvement of the patient, the prevention of complications and contractures, as well as the facilitation of
nursing and patient care. MSS treatments include non-pharmacological approaches such as rehabilitation
sessions with specialized techniques, and pharmacotherapies, including administration of oral antispastics,
intrathecal muscle relaxants, and intramuscular injections of botulinum toxin. The present consensus paper
summarizes the current evidence on pharmacological and non-pharmacological MSS treatments, providing
recommendations of an expert panel on the diagnostic approach and therapeutic management of MSS.