J Korean Med Assoc.  2007 Feb;50(2):161-169. 10.5124/jkma.2007.50.2.161.

Current Update of Antispastic Drug

Affiliations
  • 1Department of Rehabilitation Medicine and Research Institute, Yonsei University College of Medicine, Korea. kimdy@yumc.yonsei.ac.kr

Abstract

Spasticity is a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex. As one component of the upper motor neuron syndrome, spasticity remains a vexing problem for both clinicians and patients. Although several medications have been approved for clinical use in patients with spasticity, the literature has yielded no clear standard of care. The aims of this article are to review the mechanisms of spasticity, factors to consider when choosing and starting antispastic drugs in clinical settings, and the typical characteristics and effects of commonly used agents. This review will focus only on enteral medications, not neurolytic or intrathecal therapy.

Keyword

Spasticity; Drug; Mechanism; Side effect

MeSH Terms

Humans
Motor Neurons
Muscle Spasticity
Reflex, Stretch
Standard of Care
Tendons

Reference

References

1. Young RR. Spasticity: a review. Neurology. 1994; 44:S12–20.
2. Rice GP. Pharmacotherapy of spasticity: some theoretical and practical considerations. Can J Neurol Sci. 1987; 14:510–512.
Article
3. Davidoff RA. Antispasticity drugs: mechanisms of action. Ann Neurol. 1985; 17:107–116.
Article
4. Zafonte R, Lombard L, Elovic E. Antispasticity medications: uses and limitations of enteral therapy. Am J Phys Med Rehabil. 2004; 83:S50–58.
5. Bes A, Eyssette M, Pierrot?Deseilligny E, Rohmer F, Warter JM. A multi?centre, double?blind trial of tizanidine, a new antispastic agent, in spasticity associated with hemiplegia. Curr Med Res Opin. 1988; 10:709–718.
Article
6. Eyssette M, Rohmer F, Serratrice G, Warter JM, Boisson D. Multi?centre, double?blind trial of a novel antispastic agent, tizanidine, in spasticity associated with multiple sclerosis. Curr Med Res Opin. 1988; 10:699–708.
Article
7. Nance PW, Bugaresti J, Shellenberger K, Sheremata W, Mar-tinez?Arizala A. Efficacy and safety of tizanidine in the treatment of spasticity in patients with spinal cord injury. North American Tizanidine Study Group. Neurology. 1994; 44(11 Suppl 9):): S44–51;discussion. S51–52.
8. Coward DM. Tizanidine: neuropharmacology and mechanism of action. Neurology. 1994; 44(11 Suppl 9):): S6–10;discussion. S10–11.
9. Delwaide PJ, Pennisi G. Tizanidine and electrophysiologic analysis of spinal control mechanisms in humans with spasticity. Neurology. 1994; 44(11 Suppl 9):): S2–27;discussion. S27–28.
10. Naftchi NE, Kirschner AK, Demeny M, Viau AT. Alterations in norepinephrine, serotonin, c?AMP, and transsynaptic induction of tyrosine hydroxylase after spinal cord transection in the rat. Neurochem Res. 1981; 6:1205–1216.
Article
11. Maynard FM. Early clinical experience with clonidine in spinal spasticity. Paraplegia. 1986; 24:175–182.
Article
12. Donovan WH, Carter RE, Rossi CD, Wilkerson MA. Clonidine effect on spasticity: a clinical trial. Arch Phys Med Rehabil. 1988; 69(3 pt 1):193–194.
13. Herman R, Mayer N, Mecomber SA. Clinical pharmaco? physiology of dantrolene sodium. Am J Phys Med. 1972; 51:296–311.
14. Flewellen EH, Nelson TE, Jones WP, Arens JF, Wagner DL. Dantrolene dose response in awake man: implications for management of malignant hyperthermia. Anesthesiology. 1983; 59:275–280.
15. Bishop B. Spasticity: its physiology and management. Part IV. Current and projected treatment procedures for spasticity. Phys Ther. 1977; 57:396–401.
Article
16. Lin JP, Brown JK, Brotherstone R. Assessment of spasticity in hemiplegic cerebral palsy. II: Distal lower?limb reflex excitability and function. Dev Med Child Neurol. 1994; 36:290–303.
Article
17. Little J. Spasticity and associated abnormality of muscle tone. DeLIsa J, editor. Rehabilitation Medicine: Principles and Practice. 3rd ed.Philadelphia: Lippincott?Raven;2006. p. 997–1013.
18. Burke D. Spasticity as an adaptation to pyramidal tract injury. Adv Neurol. 1988; 47:401–423.
19. Nakayama R, Yano T, Ushijima K, Abe E, Terasaki H. Effects of dantrolene on extracellular glutamate concentration and neuronal death in the rat hippocampal CA1 region subjected to transient ischemia. Anesthesiology. 2002; 96:705–710.
Article
20. Francis HP, Wade DT, Turner?Stokes L, Kingswell RS, Dott CS, Coxon EA. Does reducing spasticity translate into functional benefit? An exploratory meta?analysis. J Neurol Neurosurg Psychiatry. 2004; 75:1547–1551.
Article
21. Utili R, Boitnott JK, Zimmerman HJ. Dantrolene?associated hepatic injury. Incidence and character. Gastroenterology. 1977; 72:610–616.
22. Pinder RM, Brogden RN, Speight TM, Avery GS. Dantrolene sodium: a review of its pharmacological properties and therapeutic efficacy in spasticity. Drugs. 1977; 13:3–23.
23. Terrence CF, Fromm GH. Complications of baclofen withdrawal. Arch Neurol. 1981; 38:588–589.
Article
24. Duncan GW, Shahani BT, Young RR. An evaluation of baclofen treatment for certain symptoms in patients with spinal cord lesions. A double?blind, cross? over study. Neurology. 1976; 26:441–446.
25. Taricco M, Adone R, Pagliacci C, Telaro E. Pharmacological interventions for spasticity following spinal cord injury. Cochrane Database Syst Rev. 2000; 2:CD001131.
Article
26. Gracies JM, Nance P, Elovic E, McGuire J, Simpson DM. Traditional pharmacological treatments for spasticity. Part II: General and regional treatments. Muscle Nerve Suppl. 1997; 6:S92–120.
Article
27. Stahl MM, Saldeen P, Vinge E. Reversal of fetal benzodia-zepine intoxication using flumazenil. Br J Obstet Gynaecol. 1993; 100:185–188.
Article
28. Nance P. Spasticity management. RL Braddom, editor. Physical Medicine and Rehabilitation. 3rd ed.China: Saunders Elsevier;2006. p. 651–665.
Article
29. Roussan M, Terrence C, Fromm G. Baclofen versus diazepam for the treatment of spasticity and long?term follow?up of baclofen therapy. Pharmatherapeutica. 1985; 4:278–284.
30. Dunevsky A, Perel AB. Gabapentin for relief of spasticity associated with multiple sclerosis. Am J Phys Med Rehabil. 1998; 77:451–454.
31. Basmajian JV, Shankardass K, Russell D, Yucel V. Ketazolam treatment for spasticity: double?blind study of a new drug. Arch Phys Med Rehabil. 1984; 65:698–701.
32. Cendrowski W, Sobczyk W. Clonazepam, baclofen and placebo in the treatment of spasticity. Eur Neurol. 1977; 16:257–262.
Article
33. Smolenski C, Muff S, Smolenski?Kautz S. A double?blind comparative trial of new muscle relaxant, tizanidine(DS 103–282), and baclofen in the treatment of chronic spasticity in multiple sclerosis. Curr Med Res Opin. 1981; 7:374–383.
34. Medici M, Pebet M, Ciblis D. A double?blind, long?term study of tizanidine ('Sirdalud') in spasticity due to cerebrovascular lesions. Curr Med Res Opin. 1989; 11:398–407.
Article
35. Weingarden SI, Belen JG. Clonidine transdermal system for treatment of spasticity in spinal cord injury. Arch Phys Med Rehabil. 1992; 73:876–877.
36. Stewart JE, Barbeau H, Gauthier S. Modulation of locomotor patterns and spasticity with clonidine in spinal cord injured patients. Can J Neurol Sci. 1991; 18:321–332.
Article
37. Dall JT, Harmon RL, Quinn CM. Use of clonidine for treatment of spasticity arising from various forms of brain injury: a case series. Brain Inj. 1996; 10:453–458.
38. Mandac BR, Hurvitz EA, Nelson VS. Hyperthermia associated with baclofen withdrawal and increased spasticity. Arch Phys Med Rehabil. 1993; 74:96–97.
39. Joynt RL, Leonard JA Jr. Dantrolene sodium suspension in treatment of spastic cerebral palsy. Dev Med Child Neurol. 1980; 22:755–767.
Article
Full Text Links
  • JKMA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr