CME on Spasticity is dedicated to online CME conferences, courses and presentations (slides with voice over) on spasticity, given by local and international experts. Its mission is to keep you up-to-date with the most recent developments on spasticity.
Topic
Treatment of Spasticity
Spasticity is a symptom frequently associated with neurologic disorders such as multiple sclerosis, stroke, or cerebral palsy. Treatment of spasticity may involve several approaches, including pharmacotherapy with different antispastic agents (calcium channel blockers, GABAergic agents, alpha(2)-adrenergic agonists).
"All About Tizanidine" Dr. Mark Freedman (biography) English - 2004-04-02 - 34 minutes
(29 slides)
Summary : In this presentation Dr Freedman describes several aspects of the use of tizanidine in the treatment of spasticity.
Tizanidine is an alpha-2 adrenergic agonist that acts in the brain and spinal cord, and has been shown to reduce muscle tone in MS patients with spasticity (1, 2). A review by Paisley et al showed tizanidine to be as effective as baclofen or diazepam, although less likely to cause weakness (3). Another review by Lataste et al found that tizanidine had a superior effect on clonus and muscle strength as compared to baclofen, and having good tolerability as well (4). A Cochrane Review of pharmacological treatments for spasticity in spinal cord injury found intrathecal baclofen and tizanidine to be effective in these patients(5).
Switching from baclofen to tizanidine may be considered in cases where weakness, spasms or too many side effects persist despite an adequate dose of baclofen (6).
Learning objectives : The participant will learn about the following aspects of tizanidine use in the treatment of spasticity:
-Clinical efficacy and tolerability compared to other oral antispastic agents
-Side effect profile and dose titration
-Switching from baclofen to tizanidine
"Management of Spasticity Associated with Multiple Sclerosis" Dr. Mark Freedman (biography) English - 2004-04-02 - 32 minutes
(46 slides)
Summary : Dr.Freedman’s talk covers the etiology, symptoms, and complications of spasticity in MS patients and a review of pharmacologic and non-pharmacologic symptom management.
The MS patient with spasticity suffers from limitations on his activities of daily living. The goal of treatment is therefore to improve the patient’s functionality and quality of life while decreasing concomitant pain and discomfort. The pendulum test can be used to obtain an objective rating of spasticity and is a useful tool to assess progress over time. Dr. Freedman discusses the evidence supporting various therapeutic options, ranging from combination pharmacotherapy to acupuncture, that can be applied alone or in combination to treat spasticity in MS patients.
Lepisto F. A Comparative Trial of Tizanidine and Placebo in Patients with Skeletal Muscle Spasms After Operation for Herniated Disk. Current Therapeutic Research. 1981; 30(2):141-146.
"Spasticity Treatment in MS Patients" Dr. Liesly Lee (biography) English - 2004-02-17 - 30 minutes
(21 slides)
Summary : In this presentation Dr Lee describes the treatment options available for spasticity in MS patients, outlining the pros and cons of each.
Since choosing an anti-spasticity agent depends on the patient's tolerance of the side effects, it may become necessary to switch treatment in order to ameliorate the side effects experienced by a patient which interfere with normal functioning. Here, Dr Lee describes his experience with 2 patients who were switched from baclofen to tizanidine. Both patients showed improvements in spasticity and experienced less sedation than with baclofen. It is stressed that the transition from baclofen to tizanidine should be done slowly, and Dr Lee provides some suggestions on how the doses may be adjusted gradually.
Learning objectives : After viewing this presentation the participant will be able to:
-Present two cases of MS patients with severe spasticity symptoms
-Review the treatment options
-Discuss the issues to consider when using tizanidine to treat spasticity
