New Research on Treatments for Spasticity After Stroke

A variety of treatments are available for people who experience spasticity. Depending on the severity of spasticity and other individual factors, current treatment approaches include:

• physical exercise and stretching
• braces
• oral medications, including baclofen (Lioresal), tizanidine (Zanaflex), dantrolene (Dantrium), and benzodiazepines (e.g., Valium, Xanax)
• injections, mainly botulinum toxin type A (Botox)
• medication pump therapy

Research and clinical trials focused on both preventing and treating spasticity are constantly in the works, leading to improvements in care and outcomes for people and caretakers aiming to manage this condition.

Acupuncture and dry needling

Acupuncture and dry needling, two techniques that involve having thin needles inserted into the skin, may hold some promise in reducing some symptoms of spasticity:

• Acupuncture. In a 2019 review of 11 studies and case reports, evidence suggested that acupuncture may bring an additional benefit to regular spasticity treatment after stroke.
• Fire acupuncture. According to a 2021 review, fire acupuncture, in which red-hot needles are used, may provide even more relief than conventional acupuncture for people with post-stroke spasticity.
• Dry needling. Authors of a 2020 review found evidence that dry needling can lead to a moderate decrease in post-stroke spasticity, mainly in the lower limbs.

Baclofen

In 2019, University of Minnesota researchers reported on a way of administering baclofen. Baclofen is a muscle relaxant that’s used to help some people with spasticity reduce involuntary muscle contractions, or spasms.

While the drug can be taken orally or through an injection into the spine, intravenous (IV) baclofen offers another option for people who are unable to use these methods. IV baclofen was designated as an orphan drug by the Food and Drug Administration (FDA) in 2020, with expected FDA approval for marketing by the end of 2021.

The availability of IV baclofen may help keep people from stopping the drug abruptly, which can lead to severe withdrawal symptoms.

Botulinum toxin (Botox)

Botox is a reliable treatment to relieve pain and stiffness caused by spasticity. New research from 2020 found that use of Botox may also affect contracture development after stroke.

Contracture is a serious tightening of connective tissues in a part of the body, such as the hands, wrists, or elbows, often causing pain and disability. It can be made worse by spasticity. Around half of people who experience stroke go on to develop contracture in the 6 months after stroke.

In the study, 93 people who experienced post-stroke spasticity received either Botox or placebo injections in an arm that had lost function due to the stroke. The group that received Botox had improvements in spasticity and a slower rate of contracture formation.

Cannabis

Cannabinoids are growing in popularity as potential treatment options for a variety of conditions, and they’re now being prescribed for some individuals who have spasticity.

There’s been a good amount of research on cannabinoid use in MS spasticity with positive results, but none has looked at stroke spasticity, according to a 2019 review article.

More randomized clinical trials are needed to understand the efficacy of cannabinoids as an antispastic treatment, though one cannabis-based medication, Sativex, was recently approved in the United Kingdom to treat MS spasticity.

Cannabis can be consumed in many forms, including via edibles, tinctures, and oils. Side effects vary based on the type of cannabinoid and from person to person. They include:

• dry mouth
• dizziness
• nausea

Shockwave therapy

Researchers are currently studying extracorporeal shockwave therapy to reduce muscle spasticity and improve motor recovery after a stroke. Extracorporeal means that the therapy happens on the outside of the body.

During shockwave therapy, a healthcare professional uses a handheld device to send shock waves into a certain area of your body. This helps stimulate blood flow and nerve function.

Data has shown that extracorporeal shockwave therapy can:

• promote tissue regeneration
• lead to anti-inflammatory actions in the body
• help prevent the death of tissue cells

It’s been shown to be a promising treatment for spasticity in several clinical studies, though it’s not commonly used by healthcare professionals, according to a 2020 worldwide review of studies.

Research is underway in animal models to test even more potential treatment options for spasticity. There are a few drugs that have shown some promise.

MPH-220

One important drug candidate for spasticity is MPH-220. MPH-220 is a targeted antispastic medication that may reduce spasticity and stop painful muscle contractions.

According to a 2020 article, MPH-220 allowed for muscle relaxation in human and animal models.

MPH-220 is being studied as a one-pill-per-day treatment approach with potentially less side effects than other common spasticity treatments, which can cause pain, infections, and temporary weakness.

Nimodipine

In a study published in 2020, researchers looked at the effectiveness of a high blood pressure medication in preventing spasticity. The drug nimodipine, when tested in mice, prevented the development of spasticity after spinal cord injury. This was measured through increased muscle tone and spasms.

Positive benefits remained even after treatment was completed, the researchers found.

It’s possible to treat or reduce symptoms of spasticity through proper management. There are many different options to try if you’re experiencing spasticity.

As research and technology continue to evolve, experts are discovering more and better spasticity treatments that aim to reduce side effects and pain.

You can search for open clinical trials on muscle spasticity at ClinicalTrials.gov.

The best way to learn about new possible treatments for spasticity is to speak with a treating physician who can explain what’s available and how it might affect you or your loved one’s individual needs.