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

@article{OteroRomero2016PharmacologicalMO,
  title={Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper},
  author={Susana Otero-Romero and Jaume Sastre-Garriga and Giancarlo Comi and H. P. Hartung and Per Soelberg S{\o}rensen and Alan J. Thompson and Patrick Vermersch and Ralf Gold and Xavier Montalban},
  journal={Multiple Sclerosis Journal},
  year={2016},
  volume={22},
  pages={1386 - 1396}
}
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… Expand
Sativex in the management of multiple sclerosis-related spasticity: An overview of the last decade of clinical evaluation.
TLDR
This review of the last decade of clinical evaluations as well as post-marketing studies about effectiveness and safety of Sativex in the management of MS-related spasticity opened a new opportunity for many patients withSpasticity resistant to common antispastic drugs. Expand
Nabiximols and botulinum toxin injections for patients with multiple sclerosis: efficacy on spasticity and spasms in a single-centre experience
TLDR
It is found that both BTI and nabiximols are effective in treating multiple sclerosis-related spasticity; however, BTI treatment may be more effective on spasms intensity. Expand
Non-pharmacological interventions for spasticity in adults: An overview of systematic reviews.
TLDR
There is lack of high-quality evidence for many modalities used in managing spasticity in various neurological conditions, and further research is needed to judge the effect with appropriate study designs, timing and intensity of modalities, and associate costs of these interventions. Expand
Daily Practice Managing Resistant Multiple Sclerosis Spasticity With Delta-9-Tetrahydrocannabinol: Cannabidiol Oromucosal Spray: A Systematic Review of Observational Studies
TLDR
Delta-9-tetrahydrocannabinol: cannabidiol was well tolerated in the evaluated studies in the same way as in the RCTs and no new or unexpected adverse events or safety signals were reported in everyday clinical practice. Expand
Evaluation of the cognitive benefits of intrathecal baclofen pump implantation in people with intractable multiple sclerosis related spasticity.
TLDR
In a pilot study exploring the impact of ITB on cognition, spasticity scores improved universally and beneficial effects on some measures of fatigue, anxiety, auditory attention and verbal working memory were found. Expand
Safety and efficacy of nabiximols on spasticity symptoms in patients with motor neuron disease (CANALS): a multicentre, double-blind, randomised, placebo-controlled, phase 2 trial
TLDR
In this proof-of-concept trial, nabiximols had a positive effect on spasticity symptoms in patients with motor neuron disease and had an acceptable safety and tolerability profile. Expand
Variability of Multiple Sclerosis Spasticity Symptoms in Response to THC:CBD Oromucosal Spray: Tracking Cases through Clinical Scales and Video Recordings
TLDR
In order to gain insight into patients’ response to treatment at the individual level, in-depth changes from baseline in various clinical scales and video-assessed parameters were evaluated in patients with resistant MS spasticity before and after 1 month of treatment with THC:CBD oromucosal spray. Expand
The influence of physiotherapy intervention on patients with multiple sclerosis–related spasticity treated with nabiximols (THC:CBD oromucosal spray)
TLDR
The authors' real-life study confirms nabiximols’ effectiveness in MS-related spasticity and suggests that the association of a PT program may improve overall response and persistence to nabixIMols treatment. Expand
Cannabinoids for the treatment of spasticity
TLDR
Paediatric studies of spasticity provide low quality evidence and are inadequate to inform clinical practice, and should be considered in the context of the narrow therapeutic index of cannabinoids forSpasticity and adverse effects. Expand
Botulinum toxin for the management of spasticity in multiple sclerosis: the Italian botulinum toxin network study
TLDR
Botulinum toxin was used for spasticity and its consequences from the early stages of MS, without significant adverse effects, and MS-specific goals and injection characteristics can be used to refer MS patients to BT treatment and to guide the design of future clinical trials and observational studies. Expand
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 110 REFERENCES
Non pharmacological interventions for spasticity in multiple sclerosis.
TLDR
There is 'low level' evidence for non pharmacological interventions such as physical activities given in conjunction with other interventions, and for magnetic stimulation and electromagnetic therapies for beneficial effects on spasticity outcomes in people with MS. Expand
A Benefit-Risk Assessment of Baclofen in Severe Spinal Spasticity
TLDR
The limited data on baclofen toxicity in patients with renal disease suggest that administration of the drug in these persons may carry an unnecessarily high risk, but the benefit/risk assessment is favourable. Expand
Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial
TLDR
Treatment with cannabinoids did not have a beneficial effect on spasticity when assessed with the Ashworth scale, but objective improvement in mobility and patients' opinion of an improvement in pain suggest cannabinoids might be clinically useful. Expand
The treatment of spasticity in multiple sclerosis: a double‐blind clinical trial of a new anti‐spastic drug tizanidine * compared with baclofen
TLDR
It is underscored that neither baclofen nor tizanidine are ideal antispastic drugs, and emphasize the need for further research. Expand
Drugs Used to Treat Spasticity
TLDR
Therapy for spasticity is symptomatic with the aim of increasing functional capacity and relieving discomfort, and pharmacotherapy is generally initiated at low dosages and then gradually increased in an attempt to avoid adverse effects. Expand
Prevalence and treatment of spasticity reported by multiple sclerosis patients
TLDR
In the focused survey, ITBG reported lower levels of spasticity than ORALG, less stiffness in the legs, less pain and fewer spasms at any time, which can significantly impact QOL parameters by reducing spasms, pain and fatigue. Expand
Randomized controlled trial of cannabis‐based medicine in spasticity caused by multiple sclerosis
TLDR
It is concluded that this CBM may represent a useful new agent for treatment of the symptomatic relief of spasticity in MS. Expand
Treatment of spasticity with tizanidine in multiple sclerosis.
TLDR
Tizanidine appears to reduce clinical spasticity and hyperreflexia in MS patients although no change in functional status was detected and may well serve as an alternate antispastic agent, alone or in combination with other agents. Expand
The use of baclofen in treatment of spasticity in multiple sclerosis.
  • G. Sawa, D. Paty
  • Medicine
  • The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques
  • 1979
TLDR
Baclofen was used in a double-blind crossover placebo-controlled trial to treat spasticity in patients with multiple sclerosis and was particularly effective in alleviating flexor and extensors spasms, as well as their associated pain. Expand
Managing severe lower limb spasticity in multiple sclerosis: does intrathecal phenol have a role?
TLDR
Investigating the authors' experience with lumbar intrathecal phenol injection found IP can reduce spasms and pain, leading to improvements in care and overall comfort and is an effective treatment option in the management of severe spasticity. Expand
...
1
2
3
4
5
...