57 - Management of spasticity

Summary

The main end mechanism leading to spasticity is the hyperexcitability of alphamotor neurons, caused by decreased descending inhibitory signals secondary to damage to the central nervous system (CNS). The clinical evaluations in assessment of spasticity are spasticity-related impairment, spasticity-related activity limitation and patient reported outcomes. The Multiple Sclerosis Council for Clinical Practice Guidelines published evidence-based recommendations for the management of spasticity in multiple sclerosis (MS). The recommendations are: rehabilitation and exercise, oral medications, baclofen, tizanidine, benzodiazepines, gabapentin, dantrolene sodium, clonidine, cannabinoids, cyproheptadine and low-dose naltrexone. The local treatments for spasticity include usage of anesthetic agents, chemical neurolysis, botulinum toxin and neuro-orthopedic interventions. The intrathecal medication includes intrathecal baclofen. The scarcity of scientific evidence in MS, as well as the unpredictability and heterogeneity of the disease, make it difficult for the clinician to design treatment algorithms for spasticity management that take into account all of the available modalities.