The syndrome of spasticity causes an involuntary, pathological increase in muscle tension and occurs after manifold spinal and supraspinal damage to descending motor pathways in the central nervous system. Spasms (spasms) of skeletal muscles can be observed, for example, in static and functional disorders of the spine or in various neurological diseases such as multiple sclerosis, chronic myelopathy, degenerative spinal cord disease, insult or cerebral palsy. Spastic muscles have the property of reacting to even minor stretching with pronounced shortening, severely limiting the patient’s mobility and quality of life. The shortening of the muscle (muscle contractures) can lead to poor posture of the extremities and alter muscles, joints, tendons and ligaments, often resulting in further stiffening of the musculature.1
Treatment should be primarily by means of physiotherapeutic measures to activate remaining motor functions and reduce complications, such as muscle shortening or movement disorders caused by muscle contractions. In addition, drug therapy for spasticity can reduce increased muscle tone and spasms and, according to the current guidelines, should be used when spasticity relevant to everyday life (with impairment of passive and/or active functions) cannot be adequately controlled despite adequate physical and therapeutic measures.1,2 The active ingredient tizanidine (e.g., Tizagelan®) is the most commonly prescribed agent from the group of oral, centrally acting muscle relaxants.3 The DGN S2K guideline on the diagnosis and treatment of multiple sclerosis also recommends tizanidine as the first-choice drug therapy for multiple sclerosis patients with functionally impairing spasticity.4 The treatment goals must be formulated individually for each spasticity patient depending on the severity of the spastic syndrome and existing muscle paralysis.1
1 Schwarz M. Spastik. In: Praxisbuch neurologische Pharmakotherapie. Springer Berlin Heidelberg, 2018. https://doi.org/10.1007/978-3-662-55838-6_7.
2 Platz T. et al., Therapie des spastischen Syndroms, S2k-Leitlinie, 2018, in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien (accessed: 27.01.2022).
3 DPMÖ, M03B0 (Muskelrelaxantien, zentral), MAT 11/2021 (in Einheiten).
4 Hemmer B. et al., Diagnose und Therapie der Multiplen Sklerose, Neuromyelitis-optica-Spektrum-Erkrankungen und MOG-IgG-assoziierten Erkrankungen, S2k-Leitlinie, 2021, in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien (accessed: 03.01.2022).