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Pharmacotherapy of Spasticity: Some Theoretical and Practical Considerations

Published online by Cambridge University Press:  05 January 2016

G.P.A. Rice
G.P.A. Rice*
Affiliation:
University Hospital and the University of Western Ontario, London
*
Department of Clinical Neurological Sciences, University Hospital, P.O. Box 5339, Postal Station A, London, Ontario, Canada N6A 5A5
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Abstract:

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The availability of new antispasticity agents has greatly extended the therapeutic arm of the neurologist and has obviated the need for destructive neurosurgical procedures in many instances. Baclofen remains the single most useful agent, but in certain circumstances, benzodiazepines and dantrolene sodium are useful alternative or adjunctive treatments. Tizanidine has been recently introduced, and early experience with this agent appears to be favourable. A variety of new drugs are awaiting further evaluation. The effective use of these agents demands an understanding of their principal mechanisms of action, knowledge of their predictable side effects, and a familiarity with the underlying neurological disorders. The monitoring of clinical efficacy is difficult and is often dependent upon subjective evaluation. The application of electrophysiological studies might facilitate the monitoring of treatment and the prediction of optimum treatment strategies forindividual patients. The use of these pharmacological agents, from the perspective of a clinician, will be discussed.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 14 , Issue S3 , August 1987 , pp. 510 - 512
Copyright
Copyright © Canadian Neurological Sciences Federation 1987

References

REFERENCES

1.Lance, JW.The control of muscle tone, reflexes, and movement. Neurology 1980; 30: 1303–1313.CrossRefGoogle ScholarPubMed
2.Lance, JW.Symposium synopsis. In: Feldman, RG, Young, RR, Koella, WP, eds. Spasticity: Disordered motor control. Chicago Year Book 1980; 485–494.Google Scholar
3.Hagbarth, KE.Wallin, G.Lofstedt, L.Muscle spindle responses to stretch in normal and spastic patients. Scand J Rehabil Med 1973, 5: 156–159.CrossRefGoogle Scholar
4.Pinder, RM, Brogden, RN.Speight, TM.et al. Dantrolene sodium. Drugs 1977: 13: 3–23.CrossRefGoogle ScholarPubMed
5.Denny-Brown, D.The cerebral control of movement. Liverpool. University Press, 1966.Google Scholar
6.Delwaide, PJ and Young, RR.Drug therapy. Spasticity 1981; 304: 28–33, 96–99.Google Scholar
7.Costa, E and Guidotti, A.Molecular mechanisms in the receptor action of benzodiazepines. Annu Rev Pharmacol Toxicol 1979; 19: 531–545.CrossRefGoogle ScholarPubMed
8.Barbeau, A.Preliminary study of glycine administration in patients with spasticity. Neurology 1974; 24: 392.Google Scholar
9.Maxell, DR, Sumpter, EA.A comparison of the actions of some drugs on decerebrate rigidity, muscle spindle activity, and alpha-adrenoceptors. Br J Pharmacol 1974: 50: 355–363.CrossRefGoogle Scholar
10.Delwaide, PJ.Electrophysiological analysis of the mode of action of muscle relaxants in spasticity. Ann Neurol 1985; 17: 90–95.CrossRefGoogle ScholarPubMed
11.Bass, B, Weinshenker, B.Rice, GPA.et al. Tizanidine vs baclofen in the treatment of spasticity in patients with multiple sclerosis: A double-blind study. Can J Neurol Sci (submitted).Google Scholar
12.Angel, RW, Hoffmann, WW.The H reflex in normal, spastic, and rigid subjects. Arch Neurol 1963; 8: 591–596.CrossRefGoogle Scholar
13.Burke, D, Ashby, P.Are spinal presynaptic inhibitory mechanisms suppressed in spasticity. J Neurol Sci 1972; 15: 321–326.CrossRefGoogle ScholarPubMed
14.Pierrot-Deseilligny, E, Bussel, B, Held, JP, et al. Excitability of human motoneurons after discharges in a conditioning reflex. Electroencephal Clin Neurophysiol 1976; 40: 279–287.CrossRefGoogle Scholar
15.Cook, JB, Nathan, PW.On the site of action of diazepam in spasticity in man. J Neurol Sci 1967; 5: 33.CrossRefGoogle ScholarPubMed
16.Verries, M, Ashby, P, MacLeod, S.Diazepam effect in reflex activity in patients with complete spinal lesions and in those with other causes of spasticity. Arch Phys Med Rehab 1977; 58: 148–153.Google Scholar
17.Rinne, UK.Tizanidine treatment of spasticity in multiple sclerosis and chronic myelopathy. Curr Therap Research 1980; 28: 827–836.Google Scholar
18.Smolenski, C.Muff, S and Smolenski-Kautz, S.A double-blind comparative trial of a ne w muscle relaxant tizanidine and baclofen in the treatment of chronic spasticity in multiple sclerosis. Curr Med Res Opinion 1981: 7: 374–383.Google Scholar
19.Newman, PM, Nogues, M, Newman, PK, et al. Tizanidine in the treatment of spasticity. Eur J Clin Pharm 1982: 23: 31–35.CrossRefGoogle ScholarPubMed