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

Otero-Romero, S; Sastre-Garriga, J; Comi, G; Hartung, HP; Soelberg Sørensen, P; Thompson, AJ; Vermersch, P; ... Montalban, X; + view all (2016) Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper. Multiple Sclerosis Journal , 22 (11) pp. 1386-1396. 10.1177/1352458516643600. Green open access

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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.

Type: Article
Title: Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/1352458516643600
Publisher version: http://dx.doi.org/10.1177/1352458516643600
Language: English
Additional information: Copyright © The Author(s), 2016.
Keywords: Multiple sclerosis, pharmacological treatment, review, spasticity
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/1496196
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