Skeletal muscle spasms and spasticity: Clinical considerations

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Abstract
Under appropriate conditions, virtually any striated muscle can develop painless or painful clonic or tonic spasms, leading to a wide range of clinical syndromes, from the rare “stiff‐man syndrome” to very common athletic injuries. The pathogeneses of hypertonias are legion, involving, among others, central nervous system lesions, e.g., basal ganglia disease, traumatic lesions of the spinal cord and nerve roots, encephalopathies of the “stimulus‐sensitive” type (myoclonus, hypsarrhythmia), true muscular cramps associated with electrolyte abnormalities (tetany), infections (tetanus, rabies), neurotoxins (venoms), and hereditary absence of muscle phosphorylase (McArdle's syndrome). Also, treatment involves a wide variety of modalities, from relief of spasm by local physical ameliorants to destructive surgical procedures. Intrathecal steroid injections in patients with spastic paraparesis due to multiple sclerosis produced a striking reduction of incapacitating lower limb spasticity in 3 of 10 patients treated. While responses were inconsistent and unpredictable, further careful testing is deemed warranted.

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