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More MS news articles for May 2003

Medical treatment of spasticity

Neurochirurgie 2003 May;49(2-3 Pt 2):247-55
Rode G, Maupas E, Luaute J, Courtois-Jacquin S, Boisson D.
Service de Reeducation Neurologique, Hopital Henry-Gabrielle, Hospices Civils de Lyon et Universite Cl.-Bernard Lyon-I.

Spasticity is one of the clinical signs observed after a lesion of the pyramidal tract.

Clinical manifestations are polymorphous and depend on the location of the lesion on the pre-motoneuron.

Functional consequences are also variable.

Only negative effects such as painful spasms, stiffness, distortions, are to be treated.

Three different categories of drugs are available: GABA-like (baclofen, benzodiazepine), central alpha 2 agonists (tizanidine, clonidine) and peripheral anti-spastics (dantrolene).

Baclofen remains the most commonly used anti-spastic.

The preferential indication is spasticity from spinal cord disease, especially when the aetiology is multiple sclerosis.

Efficacy of benzodiazepines (diazepam, tetrazepam, clonazepam) is comparable with baclofen; however, side effects (drowsiness) are more frequent.

Benzodiazepines are indicated when spasticity is associated with anxiety.

Tizanidine is an efficient and well tolerated antispastic.

In France, prescription requires a temporary authorization of use.

Dantrolen has a peripheral mechanism of action and can be prescribed in the different forms of spasticity.

There are other compounds with anti-spastic properties (gabapentine, cyproheptadine, piracetam).

Their advantage is rather limited when used alone.

Generally, they are administrated in combinaison with usual anti-spastic drugs.