Effect of various anti-spastic medications on spasticity in spinal cord injury cases: An Interventional Study
Abstract
Spasticity following spinal cord injury (SCI) is a common symptom which negatively affects quality of life. Despite its prevalence, spasticity as a syndrome in the SCI population is not always managed effectively because it has various presentations. Different drugs are used to manage spasticity. A prospective interventional study in 20 acute spinal cord injury patients has been done to find out the effect of various anti-spastic medications like Baclofen, Diazepam, Tizanidine, Gabapentine, on spasticity and results were measured clinically on Modified Ashworth scale (MAS), Penn Spasm Frequency scale (PSFS) and Hmax/Mmax ratio. Baclofen in dose range of 15-37.5 mg/day showed highly significant reduction in mean Hmax/Mmax ratio and significant reduction in mean PSFS. Although mean MAS also showed reduction, but this was non-significant.
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Introduction
The word 'spasticity is derived from the Greek word 'spasticus', which means 'To pull' or 'To Tug'. Spasticity is defined1 as 'Disordered sensory-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles'. In simple words, spasticity is stiffness of muscles that occurs after injury to the spinal cord or brain. Young has defined spasticity as a velocity-dependent hyperreflexia2 while the Lance3 defined it as 'a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon reflexes, resulting from excitability of the stretch reflex'.
Spasticity is the most common complication affecting the persons with spinal cord injury. 60% of the Stockholm Spinal Cord Injury had a spastic paresis and 40% of those, reported that their spasticity was problematic in their activities of daily living. 4 The prevalence of problematic spasticity has varied between 12% and 37% in different studies. 5-7
The exact pathogenesis of spasticity following SCI in patients remains uncertain. The increased excitability of the stretch reflex in patients with spasticity directed research efforts toward investigating the spinal mechanisms modulating the excitability of this reflex and the potential alteration in its excitability after SCI.
Spasticity can severely impair normal daily functions such as walking, eating, dressing and all this contributes to patient disability. The therapeutic objective is to reduce the excessive muscle tone, with the aim of increasing patient’s functionality and reducing discomfort.
Several anti-spastic drugs are available with various mechanisms of action, but none has been established as uniformly useful in reducing the spasticity. In addition, all drugs have potentially serious side effects. It is essential to weigh the benefit before considering starting them.
Conclusion
This present study concluded that Baclofen had better symptomatic relief and also greater decrease in spasticity measures. Diazepam was least effective and had sedation as side effect requiring discontinuation of drug. Gabapentin and Tizanidine were also able to give relief and were at par in effectiveness.