Anti-spasticity agents for multiple sclerosis

Shakespeare DT, Boggild M, Young C

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Summary

More research is needed into the effect of anti-spasticity agents for people with multiple sclerosis

Multiple sclerosis (MS) is a chronic disease of the nervous system which affects young and middle-aged adults. Spasticity, a common problem in people with MS, is a disorder of voluntary movement caused by damage to the central nervous system. The main sign is the resistance to passive movement of a limb but other associated features - pain, spasms, loss of function - affect people's quality of life more directly.
Many anti-spasticity drugs are available but the review of trials found that there is not enough evidence to compare their effectiveness.
More research is needed.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Shakespeare DT, Boggild M, Young C. Anti-spasticity agents for multiple sclerosis. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD001332. DOI: 10.1002/14651858.CD001332.

This version first published online: October 23. 2000
Date of last substantive update: July 14. 2003

Abstract

Background

Spasticity is a common problem in multiple sclerosis (MS) patients causing pain, spasms, loss of function and difficulties in nursing care. A variety of oral and parenteral medications are available.

Objectives

To assess the absolute and comparative efficacy and tolerability of anti-spasticity agents in MS patients.

Search strategy

We searched the Cochrane MS Group trials register (June 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2003), MEDLINE (January 1966 to June 2003), EMBASE (January 1988 to June 2003), bibliographies of relevant articles, personal communication, manual searches of relevant journals and information from drug companies.

Selection criteria

Double-blind, randomised controlled trials (either placebo-controlled or comparative studies) of at least seven days duration.

Data collection and analysis

Two independent reviewers extracted data and the findings of the trials were summarised. Missing data were collected by correspondence with principal investigators. A meta-analysis was not performed due to the inadequacy of outcome measures and methodological problems with the studies reviewed.

Main results

Twenty-six placebo-controlled studies (using baclofen, dantrolene, tizanidine, botulinum toxin, vigabatrin, prazepam, threonine and cannabinoids) and thirteen comparative studies met the selection criteria and were included in this review. Only fifteen of these studies used the Ashworth scale, of which only three of the eight placebo-controlled trials and none of the seven comparative studies showed a statistically significant difference between test drugs. Spasms, other symptoms and overall impressions were only assessed using unvalidated scores and results of functional assessments were inconclusive.

Authors' conclusions

The absolute and comparative efficacy and tolerability of anti-spasticity agents in multiple sclerosis is poorly documented and no recommendations can be made to guide prescribing. The rationale for treating features of the upper motor neurone syndrome must be better understood and sensitive, validated spasticity measures need to be developed.

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