From the Guidelines
Spasticity management should prioritize botulinum toxin for patients with focal spasticity that is painful, impairs function, reduces the ability to participate in rehabilitation, or compromises proper positioning or skin care, as recommended by the most recent guidelines 1. Spasticity is a condition characterized by muscle stiffness and involuntary contractions, commonly occurring after neurological injuries like stroke, multiple sclerosis, cerebral palsy, or spinal cord injury. About 65-78% of stroke survivors develop some degree of spasticity, while 40-60% of multiple sclerosis patients experience it during their disease course.
Treatment Options
- Oral medications such as baclofen (starting at 5mg three times daily, gradually increasing to 20-25mg three times daily as needed) or tizanidine (2-4mg initially, increasing to 8mg three times daily maximum) may be used for treatment, but botulinum toxin injections (Botox 100-400 units depending on affected muscles) are recommended for localized spasticity 1.
- Severe cases may require intrathecal baclofen therapy via an implanted pump delivering 50-800 micrograms daily directly to the spinal cord, as suggested by recent guidelines 1.
- Physical therapy, including stretching and range-of-motion exercises, is essential alongside medication for optimal management.
Importance of Management
Spasticity management is important not only for comfort but also to prevent complications like contractures and pressure sores that can develop when muscles remain contracted for extended periods.
Recent Guidelines
Recent guidelines from the U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines recommend botulinum toxin for patients with focal spasticity that is painful, impairs function, reduces the ability to participate in rehabilitation, or compromises proper positioning or skin care 1.
Insufficient Evidence
There is insufficient evidence to recommend for or against the use of acupuncture or dry needling for spasticity management, as well as whole body or localized muscle vibration, or extracorporeal shock wave therapy 1.
From the FDA Drug Label
Baclofen tablets are useful for the alleviation of signs and symptoms of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity. Tizanidine’s capacity to reduce increased muscle tone associated with spasticity was demonstrated in two adequate and well controlled studies in patients with multiple sclerosis or spinal cord injury.
The answer to spasticity statistics is that both baclofen and tizanidine are used to alleviate signs and symptoms of spasticity.
- Baclofen is used for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity in patients with multiple sclerosis 2.
- Tizanidine has been shown to reduce increased muscle tone associated with spasticity in patients with multiple sclerosis or spinal cord injury, with a statistically significant reduction in muscle tone and frequency of spasms compared to placebo 3.
From the Research
Spasticity Statistics
- Spasticity is a common problem in pediatric neurology and its management constitutes a real professional challenge 4
- Oral baclofen has long been a mainstay in the management of spasticity, and results suggest that it may be effective in many patients with spasticity, regardless of the underlying disease or severity 5
- However, adverse effects, such as muscle weakness, nausea, somnolence, and paraesthesia, are common with oral baclofen, affecting between 25% and 75% of patients, and limiting its usefulness 5
Treatment Options
- There are numerous therapeutic options available for the treatment of spasticity, including oral medications, injections of phenol or botulinum toxin, or surgical intervention 6
- Intrathecal baclofen may be an effective alternative to oral baclofen, as it delivers the drug directly into the cerebrospinal fluid, bypassing the blood-brain barrier and minimizing drug-related side effects 5, 6
- Other oral antispasticity drugs, such as tizanidine, diazepam, dantrolene, and gabapentin, have been found to be moderately effective in tackling spasticity 7
Efficacy and Safety
- The efficacy and safety of oral baclofen in the management of spasticity have been extensively studied, and results suggest that it is at least comparable with other antispasmodic agents 5
- However, the incidence of adverse effects is reported to range from 10% to 75%, and the rate of treatment discontinuation due to intolerable adverse effects has generally been reported to range from 4% to 27% 6
- Intrathecal baclofen has been found to be cost-effective, with costs that may or may not be avoided in the healthcare system 6