Spasticity Treatment

The goal of spasticity treatment is managing symptoms, since there is currently no cure for the condition. The earlier your child is evaluated, the better, so that treatment can begin sooner and hopefully avoid the need for surgery later.

We review all possible treatments available and draw on those that are most likely to help your child. As time goes on, we may modify the treatments through the feedback that you and your child give us.

Physical and occupational therapy for spasticity

Therapy is the first line of defense in diminishing muscle stiffness. Physical therapists (PTs) and occupational therapists (OTs) evaluate your child and recommend exercises that can help improve walking and activities of daily living such as getting dressed, eating, and using the toilet.

• The therapists assess your child’s strength, the range of motion, and the presence of tone or rigidity in his or her arms and legs. They determine the level of support your child needs to move in his or her natural environment (such as walking, crawling, or sitting), to participate in self-care, and to engage in play.
• They may recommend exercises, durable medical equipment (DME), braces or splints, or outpatient therapies to help promote greater independence for your child.

Medication for spasticity

Various anti-spasmodic medications may help diminish spasticity. Some are taken orally, others injected. They all need careful monitoring because they can sometimes affect all muscles, not just the spastic ones, resulting in overall body weakness.

• Botulinum toxin. This medication is used to temporarily decrease muscle tone and help create more effective movement. It is injected directly into an affected muscle.
• Baclofen. This is a medication that is given either by mouth or by injection. But some children can’t tolerate baclofen injections because the medication makes them very drowsy. In those cases, a pump can be implanted in your child’s abdomen, with a tiny tube extended directly into the spinal cord. A helpful amount of the baclofen can be automatically released into the spinal cord around the clock as needed.

Orthopedic surgery for spasticity

Spastic muscles can pull bones out of alignment because while bones continue to grow, the muscles may not. These conditions can be corrected by surgery. Typical surgeries include:

• Realigning bones that have been pulled out of alignment
• Relocating joints, such as hips, that are dislocated
• Lengthening muscles to improve their function
• Cutting certain tendons to decrease muscle tone

Neurosurgery for spasticity

Selective dorsal rhizotomy.

Neurosurgeons at Lucile Packard Children’s Hospital Stanford have helped many children with the selective dorsal rhizotomy (SDR) procedure, often with dramatic improvement, especially in younger children and those with lower-limb spasticity.

• Using minimally invasive techniques, the neurosurgeon makes a small incision in your child’s back. With precise tools viewed under a microscope, the surgeon can enter the spine to determine which nerve roots are preventing muscles from relaxing.
• During the surgery, electronic devices are used to monitor individual nerves in the spinal cord.
• Impaired nerve roots are cut, so they no longer inhibit the normal relaxation response to stretching.
• SDR is followed by intensive physical and occupational therapy, usually in the inpatient setting for three to six weeks followed by outpatient therapy.

Not all children are candidates for SDR, so consider this option carefully with advice and input from your care team.

Baclofen pump placement.

Some children find that baclofen injections make them too drowsy. For some of them, a baclofen pump may be implanted so that the baclofen can be delivered directly into the spinal fluid. The neurosurgeon will test the right amount of baclofen to administer through the pump to be sure it provides the best possible outcome. The pump needs to be refilled every four to six months, depending on the size of the pump and the dose needed.

Deep brain stimulation.

A novel treatment known as (DBS) uses computer technology to locate the areas of the brain that are misfiring and then modify those areas with impulses from an implanted electronic device.

DBS was developed for adults about 20 years ago. In the past decade, it’s been in use for children with movement disorders including spasticity. As with other surgeries, not all children will respond to this procedure, so you and your team will carefully analyze all available data to determine if DBS might benefit your child.

• Lucile Packard Children’s Hospital Stanford is one of the few children’s hospitals on the West Coast able to treat spasticity and other movement disorders with DBS.
• DBS can result in remarkable improvements in children with movement disorders. It can be used along with medication and therapy.
• The device acts like a pacemaker for use with the brain instead of the heart. It is programmed so that it can block the misfiring brain signals that cause spasticity.
• The implant can be removed if necessary. This may be useful if new or improved medications are created in the future, making the implanted device unnecessary.