Spasticity in multiple sclerosis and role of glatiramer acetate treatment

Abstract

IntroductionSpasticity is one of the most disabling and difficult-to-treat symptoms shown by patients with multiple sclerosis, who often show a suboptimal and unsatisfactory response to classic treatment and new available nonpharmacological alternatives. Due to the progressive nature of this condition, the early management should be essential to improve long-term outcomes.MethodsWe performed a narrative literature review of the contribution of spasticity to the burden of multiple sclerosis and the potential role of classic disease-modifying drugs.ResultsAdded to the underlying pathophysiology of spasticity, certain external factors and drugs such as interferon may exacerbate the existing condition, hence their awareness is crucial as part of an effective management of spasticity. Furthermore, the evidence for the effectiveness of glatiramer acetate in preventing spasticity in naïve patients and in those switching from interferon should not be ignored.ConclusionsThis literature review proposes the examination of spasticity and the influence of classic disease-modifying agents on the level of existing condition among the variables to be considered when deciding on therapy for multiple sclerosis in clinical practice.

Baclofen in the Therapeutic of Sequele of Traumatic Brain Injury: Spasticity

“…Other alternative strategies for spasticity management are nonpharmacologic options such as: (1) orthopedic management (reconstructive surgery of upper extremity, soft tissue operations or bony procedures for treatment of hip deformities, and surgical correction or orthotic treatment of foot abnormalities and spine abnormalities 84–87 ); (2) selective dorsal rhizothomy (surgical resection of selected dorsal roots for reduce afferent input to the spinal reflex arc and dampen the muscle elongation 88–90 ); (3) stretching, fitting of splints/braces or serial casting, ultrasound and thermotherapy, neuromuscular electrical stimulation, muscle strengthening, or use of robotics to perform stretching and movement training 91,92 ; and others pharmacologic treatment options such as the following: (1) local injections of phenol (≥3%) or alcohol (≥50%) that induces chemical neurolysis and performed on motor nerves, which reduces the symptoms of spasticity 93 ; (2) antiepileptic drugs, such as gabapentin or pregabalin, has been used as adjunct therapies particularly when central neuropathic pain is present 94,95 ; (3) immunomodulators (interferon beta and glatiramer acetate), Sativex (agonist at cannabinoid receptors) and cannabis that have been used in some countries for treatment of spasticity only in multiple sclerosis 96–100 ; and (4) Zolpidem, a nonbenzodiazepine approved for the treatment of insomnia, for treatment of neurological complications (including spasticity after of hypoxic ischemic in brain injury). 101 Others alternative used in spasticity management is the administration of natural agents as the oil of Alpinia zerumbet , which has been used in patients with clinical diagnosis of stroke who presented spasticity.…”

A review of treatment of relapsing-remitting type of multiple sclerosis (RRMS)

“…A very important part of preventing spasticity is avoiding the triggering and aggravating factors which include: infections, stress, constipation, excessive fatigue, fever and certain medicines (some antidepressants and DMTs like interferon) [60]. Non-pharmacological actions that are effective should comprise physiotherapy -it was proven that it decreases the spasticity and also improves the overall response to disease-modifying treatment [61].…”

Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms—A Narrative Review

“…In a survey of participants in the North American Research Committee on Multiple Sclerosis registry, 65% of respondents indicated they would definitely or probably consider physician-assisted suicide if experiencing unbearable pain, demonstrating the impact of chronic pain on QoL and hopelessness, and the urgent need to address pain [ 58 ]. For some individuals with MS, pain may trigger or aggravate spasticity, which occurs in approximately 40% of people living with MS [ 59 , 60 ]. Spasticity, defined as feelings of stiffness and/or involuntary muscle movements, may manifest within a wide range of severity [ 61 ].…”

“…Spasticity, defined as feelings of stiffness and/or involuntary muscle movements, may manifest within a wide range of severity [ 61 ]. People living with MS have reported that spasticity has negative impacts on their activities of daily living and QoL [ 60 ].…”