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

Susana Otero-Romero; Jaume Sastre-Garriga; Giancarlo Comi; Hans-Peter Hartung; Per Soelberg Sørensen; Alan J Thompson; Patrick Vermersch; Ralf Gold; Xavier Montalbán

doi:10.1177/1352458516643600

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

Susana Otero-Romero^*, Jaume Sastre-Garriga, Giancarlo Comi, Hans-Peter Hartung, Per Soelberg Sørensen, Alan J Thompson, Patrick Vermersch, Ralf Gold, Xavier Montalbán

^*Corresponding author for this work

Department of Clinical Medicine

60 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Multiple Sclerosis
Volume	22
Issue number	11
Pages (from-to)	1386-1396
Number of pages	11
ISSN	1352-4585
DOIs	https://doi.org/10.1177/1352458516643600
Publication status	Published - Oct 2016

Keywords

Multiple sclerosis
pharmacological treatment
review
spasticity

Access to Document

10.1177/1352458516643600

Cite this

@article{51a7151d18104dd4a7fcacd2ca3fc867,

title = "Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper",

abstract = "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.",

keywords = "Multiple sclerosis, pharmacological treatment, review, spasticity",

author = "Susana Otero-Romero and Jaume Sastre-Garriga and Giancarlo Comi and Hans-Peter Hartung and {Soelberg S{\o}rensen}, Per and Thompson, {Alan J} and Patrick Vermersch and Ralf Gold and Xavier Montalb{\'a}n",

year = "2016",

month = oct,

doi = "10.1177/1352458516643600",

language = "English",

volume = "22",

pages = "1386--1396",

journal = "Multiple Sclerosis Journal",

issn = "1352-4585",

publisher = "SAGE Publications",

number = "11",

}

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 -

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

Abstract

Keywords

Access to Document

Fingerprint

Cite this