Muscle spasm is a particular feature of spinal (including brain stem) origin spasticity as described above under Pathophysiology of spasticity.10,11 Mass extensor spasms affect lower limbs, trunk and, in higher lesions, the upper limbs (Figure 33.1). In severe spasticity, flexor spasms of the lower limbs also occur (Figure 33.2) and may be associated with pain in those people with preserved sensation. These sorts of spasms frequently occur in people with poor or absent sensation where the typical muscle pain cannot be expressed. It is often the spasms themselves rather than the pain that require treatment.12 Even so, pain not infrequently accompanies these spasms and can be very severe. Chronic muscle spasticity will
frequently be felt as tightness or discomfort or pain, even in the absence of spasms.
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