Major review of the research
Jonathan Marsden, a UK Professor, oversaw this review. He is a global authority on spasticity and its management, and has studied HSP for many years.
Here are some of the review’s highlights:
- spasticity is difficult to manage and requires a collaborative approach involving multiple disciplines – doctors, physiotherapists, occupational therapists, orthotists, nurses and wheelchair engineers
- the evidence for both drug and non-drug treatments of spasticity is limited
- determining the effectiveness of various treatments of spasticity requires more research
- referral to a rehabilitation specialist should be considered if oral anti-spasticity drugs don’t work well or aren’t tolerated; if the spasticity affects posture mobility and care; or if the spasticity is associated with considerable pain and discomfort
- there is currently little evidence for the effectiveness of several physical modalities including extracorporeal shock wave therapy, whole-body vibration, transcutaneous electrical stimulation, repetitive transcranial magnetic stimulation, transcranial direct current stimulation and electromagnetic therapy
- reduction of spasticity often unmasks underlying weakness. All anti-spasticity drugs cause muscle weakness. There is a trade-off between spasticity and weakness, as spasticity can provide some measure of postural stability and function
- there is currently limited evidence for the efficacy of oral anti-spasticity drugs
- oral anti-spasticity drugs should be started at a small dose and increased in small increments. Their effectiveness for an individual should be periodically reviewed and tapered off and stopped if not effective
- the timing of taking oral anti-spasticity drugs and the dose should be tailored to the individual and to their lifestyle e.g. if walking, lower doses during daytime; the dose before bedtime and straight after waking up to reduce high tone
- oral cannabis extracts do not change objective measures of spasticity
- intrathecal baclofen, where a small precise dose is accurately delivered, results in a significant reduction in spasticity for carefully selected and screened patients who do not respond to other forms of treatment
- phenol injections can be effective in treating spasticity in large powerful muscle groups close to the trunk such as the abductors of the thighs.
SOURCE: BMJ. 2014 Aug 5;349:g4737. doi: 10.1136/bmj.g4737.
The management of spasticity in adults.
Nair KP1, Marsden J2
1Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK siva.nair@sth.nhs.uk.
2School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK.
