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Anti-spasticity agents for multiple sclerosis.

D T Shakespeare¹, C A Young, M Boggild

¹The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, UK, L9 7LJ. boggil-m@wcnn.co.uk

The Cochrane Database of Systematic Reviews

|October 18, 2000

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Evidence for anti-spasticity agents in multiple sclerosis (MS) is limited. Current studies lack validated measures, preventing recommendations for effective treatment of MS spasticity.

Area of Science:

Neurology
Pharmacology
Clinical Trials

Background:

Spasticity is a prevalent and debilitating symptom in multiple sclerosis (MS).
It significantly impacts patient quality of life, causing pain, spasms, functional loss, and care challenges.
Existing oral and parenteral medications offer varied approaches to management.

Purpose of the Study:

To evaluate the efficacy and tolerability of anti-spasticity medications in MS patients.
To compare the effectiveness of different agents used for spasticity management.

Main Methods:

Systematic review of randomized controlled trials (RCTs) identified through comprehensive literature searches.
Inclusion criteria specified double-blind, placebo-controlled or comparative studies of at least seven days duration.

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Data extraction by two independent reviewers; meta-analysis was precluded by data limitations.

Main Results:

Twenty-three placebo-controlled and thirteen comparative studies met the criteria, involving agents like baclofen, dantrolene, and tizanidine.
Few studies utilized validated scales like the Ashworth scale, with limited statistically significant findings.
Outcome measures for spasms, symptoms, and functional assessments were often unvalidated or inconclusive.

Conclusions:

The current evidence base for anti-spasticity agents in MS is insufficient to guide clinical prescribing.
Further research is needed to understand the underlying mechanisms of upper motor neuron syndrome.
Development of sensitive and validated measures for spasticity assessment is crucial.