Author Topic: (Abst.) Pharmacological management of MS spasticity  (Read 33 times)

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Offline agate

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(Abst.) Pharmacological management of MS spasticity
« on: May 22, 2016, 12:13:55 pm »
From Multiple Sclerosis Journal, May 19, 2016:

Quote
Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper

Susana Otero-Romero
Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d’Hebron University Hospital, Barcelona, Spain/Preventive Medicine and Epidemiology Department, Vall d’Hebron University Hospital, Barcelona, Spain

Jaume Sastre-Garriga
Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d’Hebron University Hospital, Barcelona, Spain

Giancarlo Comi
Neurological Department, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, University Vita-Salute San Raffaele, Milan, Italy

Hans-Peter Hartung
Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany

Per Soelberg Sørensen
Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

Alan J Thompson
Department of Brain Repair & Rehabilitation, Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK

Patrick Vermersch
Université Lille, INSERM, CHU Lille, Lille Inflammation Research International Center (LIRIC) UMR 995, Lille, France

Ralf Gold
Department of Neurology, Ruhr University, St. Josef-Hospital, Bochum, Germany

Xavier Montalban
Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d’Hebron University Hospital, Barcelona, Spain
Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron, 119-129, 08035 Barcelona, Spain. sotero@cem-cat.org

Background and objectives:


Treatment of spasticity poses a major challenge given the complex clinical presentation and variable efficacy and safety profiles of available drugs. We present a systematic review of the pharmacological treatment of spasticity in multiple sclerosis (MS) patients.

Methods:

Controlled trials and observational studies were identified. Scientific evidence was evaluated according to pre-specified levels of certainty.

Results:

The evidence supports the use of baclofen, tizanidine and gabapentin as first-line options. Diazepam or dantrolene could be considered if no clinical improvement is seen with the previous drugs. Nabiximols has a positive effect when used as add-on therapy in patients with poor response and/or tolerance to first-line oral treatments.

Despite limited evidence, intrathecal baclofen and intrathecal phenol show a positive effect in severe spasticity and suboptimal response to oral drugs.

Conclusion:

The available studies on spasticity treatment offer some insight to guide clinical practice but are of variable methodological quality. Large, well-designed trials are needed to confirm the effectiveness of antispasticity agents and to produce evidence-based treatment algorithms.





SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010.

 

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