A Review of Spasticity Treatments: Pharmacological and Interventional Approaches

Abstract

Spasticity is a velocity-dependent increase in muscle tone and uncontrolled, repetitive, involuntary contractions of skeletal muscles. Spasticity presents as upper motor neuron symptoms in patients with central nervous system pathology such as stroke, spinal cord injury, brain injury, or multiple sclerosis. As a result, a patient can have significant pain and limited mobility, which can lead to decreased quality of life and difficulty maintaining personal care. In this article we discuss mechanisms, indications, efficacy, and side effects of the most accepted current treatments. Currently available treatment options include oral medications and interventional procedures. Oral medications comprise centrally acting agents, such as baclofen, clonidine, and tizanidine, as well as anticonvulsants such as benzodiazepines and gabapentin and peripherally acting dantrolene. Interventional procedures include focal injections of botulinum toxin, phenol or alcohol, and an intrathecal baclofen pump. Surgical treatments include selective dorsal rhizotomy and neurectomy. We found that there are several treatments available with data to support their use, but many still need further research to prove their efficacy and develop optimal utilization.

Baclofen in the Therapeutic of Sequele of Traumatic Brain Injury: Spasticity

“…Other alternative strategies for spasticity management are nonpharmacologic options such as: (1) orthopedic management (reconstructive surgery of upper extremity, soft tissue operations or bony procedures for treatment of hip deformities, and surgical correction or orthotic treatment of foot abnormalities and spine abnormalities 84–87 ); (2) selective dorsal rhizothomy (surgical resection of selected dorsal roots for reduce afferent input to the spinal reflex arc and dampen the muscle elongation 88–90 ); (3) stretching, fitting of splints/braces or serial casting, ultrasound and thermotherapy, neuromuscular electrical stimulation, muscle strengthening, or use of robotics to perform stretching and movement training 91,92 ; and others pharmacologic treatment options such as the following: (1) local injections of phenol (≥3%) or alcohol (≥50%) that induces chemical neurolysis and performed on motor nerves, which reduces the symptoms of spasticity 93 ; (2) antiepileptic drugs, such as gabapentin or pregabalin, has been used as adjunct therapies particularly when central neuropathic pain is present 94,95 ; (3) immunomodulators (interferon beta and glatiramer acetate), Sativex (agonist at cannabinoid receptors) and cannabis that have been used in some countries for treatment of spasticity only in multiple sclerosis 96–100 ; and (4) Zolpidem, a nonbenzodiazepine approved for the treatment of insomnia, for treatment of neurological complications (including spasticity after of hypoxic ischemic in brain injury). 101 Others alternative used in spasticity management is the administration of natural agents as the oil of Alpinia zerumbet , which has been used in patients with clinical diagnosis of stroke who presented spasticity.…”

The Effect of Alpinia zerumbet Essential Oil on Post‐Stroke Muscle Spasticity

“…Other approved treatments such as baclofen, benzodiazepines (central action) and dantrolene (peripheral) may also present important side effects, such as systemic muscle relaxation, sedation, fatigue, tolerance, dependence and liver toxicity, while surgical procedures are invasive [42]. Moreover, most of these approaches still need further research to determine their efficacy and optimal utilization.…”

Preparation and Characterization of Sustained Release Matrix Tablets of Tizanidine Hydrochloride for Spinal Injuries

“…Nonsteroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants are frequently used for alleviating the pain, inflammation, and spasticity [6,7]. The chronic pain associated with SI is effectively treated with muscle relaxants like tizanidine hydrochloride (TH).…”

“…It reduces pathologically increased painful spasticity, especially in patients with spinal cord injury. In animal studies, its mechanism of action involves depressing polysynaptic reflexes, probably by antagonizing the excitatory actions of spinal interneurons [6][7][8]. In addition, it is effective in reducing muscle tone in spastic patients.…”