TY - JOUR
T1 - Pharmacological management of spasticity in multiple sclerosis
T2 - Systematic review and consensus paper
AU - Otero-Romero, Susana
AU - Sastre-Garriga, Jaume
AU - Comi, Giancarlo
AU - Hartung, Hans-Peter
AU - Soelberg Sørensen, Per
AU - Thompson, Alan J
AU - Vermersch, Patrick
AU - Gold, Ralf
AU - Montalbán, Xavier
PY - 2016/10
Y1 - 2016/10
N2 - 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.
AB - 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.
KW - Multiple sclerosis
KW - pharmacological treatment
KW - review
KW - spasticity
U2 - 10.1177/1352458516643600
DO - 10.1177/1352458516643600
M3 - Review
C2 - 27207462
AN - SCOPUS:84989898286
SN - 1352-4585
VL - 22
SP - 1386
EP - 1396
JO - Multiple Sclerosis Journal
JF - Multiple Sclerosis Journal
IS - 11
ER -