Spasticity due to multiple sclerosis
Spasticity is common in multiple sclerosis (MS), due to corticospinal tract damage. Appropriate management can reduce pain, improve mobility and prevent contractures. Start therapy at low doses, to prevent flaccidity (with a paradoxical decrease in mobility) and adverse effects. Use:
baclofen 5 mg orally, 3 times daily, initially. Increase daily dose by 10 to 15 mg every 3 days to optimum response. Usual optimum dose is 10 to 25 mg 3 times daily (maximum daily dose 100 mg in 3 divided doses). Review after 6 to 8 weeks. If stopping therapy, reduce dose slowly over 2 weeks, to avoid withdrawal syndrome. spasticity (multiple sclerosis) baclofen
A benzodiazepine may be added at night to help spasms. Clonazepam is better tolerated than diazepam. Add:
1 clonazepam 0.5 mg orally, once daily at night. If needed, increase up to 2 mg at night spasticity (multiple sclerosis) clonazepam
OR
2 diazepam 2.5 mg orally, once daily at night. If needed, increase up to 5 mg at night. spasticity (multiple sclerosis) diazepam
If this treatment does not reduce spasticity, refer for expert advice. Gabapentin can be useful when the patient also has neuropathic pain and spasms.
Medicinal cannabis (nabiximols and other cannabis products) has been used overseas to treat spasticity in MS.