Spasticity patterns assessment and recognition for therapeutic approaches (SPARTA) in multiple sclerosis: a multicenter epidemiological study

Background: Spasticity and muscle weakness are the most disabling symptoms in people with Multiple Sclerosis (pwMS), frequently affecting lower limbs and causing motor impairments, fatigue and increased risk of falls. Previous epidemiological studies on pwMS reported prevalence of spasticity and other symptoms but scarce information is available about combined patterns of muscle weakness and spasticity, symmetry and regional localization. Objectives: To describe the prevalent combined patterns of muscle weakness and spasticity in pwMS in order to focus attention on their functional balance before spasticity treatment. Methods: pwMS with lower limb spasticity, 3.5 ≤ Expanded-Disability-Status Scale (EDSS) ≤ 6.5 were recruited. Data regarding muscle weakness and spasticity, symmetry and involvement of other functional systems were collected. Prevalence analysis was performed. Results: Three-hundred pwMS were included. Muscle weakness and spasticity occurred mostly asymmetrically with a prevalence of paraparesis. Incidence of both symptoms increase with higher EDSS, particularly of muscle weakness. Twelve prevalent combined patterns were identified, with highest incidence of combinations characterized by "distal-intermediate spasticity and diffuse weakness" (29.3%), "diffuse spasticity and weakness" (13.7%), "distal spasticity and diffuse weakness" (11.7%). Conclusions: This study highlighted the most prevalent combined patterns of weakness and spasticity, useful in clinical practice for pwMS' assessment by supporting optimal planning of specific pharmacologic and rehabilitative treatments.