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. 2000;2003(4):CD001332.
doi: 10.1002/14651858.CD001332.

Anti-spasticity agents for multiple sclerosis

D T Shakespeare  1 , C A Young, M Boggild
Affiliations

Anti-spasticity agents for multiple sclerosis

D T Shakespeare et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: Spasticity is a common problem in 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 multiple sclerosis (MS) patients.

Search strategy: Randomised controlled trials (RCTs) of anti-spasticity agents were identified using MEDLINE, EMBASE, 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-three placebo-controlled studies (using baclofen, dantrolene, tizanidine, botulinum toxin, vigabatrin, prazepam and threonine) and thirteen comparative studies met the selection criteria. Only thirteen of these studies used the Ashworth scale, of which only three of the six 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.

Reviewer's 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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Conflict of interest statement

None

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Levine 1968 {published data only}
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Levine 1969 {published data only}
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Levine(1) 1977 {published data only}
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Levine(2) 1977 {published data only}
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Link 1999 {published data only}
    1. Link A, Kabus C, Haas J. Use of spasmography to assess the effects of botulinum toxin type A in patients with lower‐limb spasticity. European Journal of Neurology 1999;6(Supplement 4):S69‐73.
Lossius 1985 {published data only}
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Loubser 1991 {published data only}
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Mai 1979 {published data only}
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Mayer 1973 {published data only}
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Medici 1985 {unpublished data only}
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Meinck 1989 {published data only}
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Meyler 1981 {published data only}
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Mondrup 1983 {published data only}
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Monster 1973 {published data only}
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Monster 1974 {published data only}
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Mueller 1997 {published data only}
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Muller 1987 {published data only}
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Mutani 1971 {published data only}
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Neretin 1978 {published data only}
    1. Neretin VI, Kir'iakov VA, Pegova LN. [Experience using sinakten‐retard in the treatment of muscular sclerosis] [Russian]. Zhurnal Nevropatologii i Psikhiatrii Imeni S ‐ S ‐ Korsakova 1978;78(4):514‐8. - PubMed
Newman 1982 {published data only}
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Nielsen(1) 2000 {published data only}
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Nielsen(2) 2000 {published data only}
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Ochs 1989 {published data only}
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Ordia 1996 {published data only}
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Orsnes(1) 2000 {published data only}
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Orsnes(2) 2000 {published data only}
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Pagano 1988 {published data only}
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Parke 1989 {published data only}
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Patterson 1994 {published data only}
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Pederson 1970 {published data only}
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Penders 1976 {published data only}
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Penn 1985 {published data only}
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Penn 1989 {published data only}
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Penn 1992 {published data only}
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Perkin 1976 {published data only}
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Petro 1980 {published data only}
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Petro 1981 {published data only}
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Polman 1994 {published data only}
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Porsasz 1981 {published data only}
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Reisner 1978 {published data only}
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Ringwald 1977 {published data only}
    1. Ringwald E, Campean SJ, Gerstenbrand F, Lorincz A, Lorincz P, Ludin HP. [Clinical experiences with a new muscle relaxant (DS103‐282 Sandoz)] [German] [Klinische Erfahrungen mit einem neurartigen Myotonolytikum (DS 103‐282 Sandoz)]. Nervenarzt 1977;48(7):355‐8. - PubMed
Rodgers 1999 {published data only}
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Roussan 1982 {published data only}
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Rudick 1987 {published data only}
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Smith 1991 {published data only}
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Ungerleider 1987 {published data only}
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van Ouwenaller 1985 {published data only}
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Verrier 1977 {published data only}
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Wickstrom 1987 {published data only}
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Wilson 1966 {published data only}
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