Peripheral and central effect of baclofen on ankle joint stiffness in multiple sclerosis.
The effect of baclofen on the soleus stretch reflex and peripheral muscle function was tested in 10 multiple sclerosis (MS) patients with spasticity in the lower extremities. Peroral baclofen (15-60 mg daily) induced a decrease in the twitch torque of the soleus muscle elicited by supramaximal nerve stimulation. The torque was 15.1 +/- 5.5 Nm with baclofen and 17.1 +/- 5.0 Nm without baclofen (P = 0.03). The slope of the background torque/EMG relation was also changed from 1.53 Nm/microV with baclofen to 1.13 NM/microV without it (P = 0.03), and the soleus stretch reflex threshold decreased from 11.4 degrees /s (3.1-62.8) to 6.2 degrees /s (3.1-25.1) without baclofen medication (P = 0.03) in the relaxed muscle. Furthermore, baclofen induced an approximately 20% decrease in the total stiffness at the ankle joint at all contraction levels due to a decrease in the short-latency stretch reflex. From a clinical point of view, the peripheral action of baclofen may be unfortunate. Spasticity is often accompanied by weakness, which may be the major cause of any disability. Consequently, reduction in spasticity by the central effect of baclofen may be counteracted by its influence on muscle properties. In addition, treatment of spasticity by baclofen may unmask weakness.
Nielsen
J F
JF
Center for Sensory-Motor Interaction, Department of Medical Informatics and Image Analysis, Aalborg University, Fredrik Bajers Vej 7D-3, 9220 Aalborg O, Denmark. jfn@akhpd.au.dk
Sinkjaer
T
T
D000328:Adult; D000843:Ankle Joint; D001418:Baclofen / Q000627:therapeutic use*; D001696:Biomechanical Phenomena; D002490:Central Nervous System / Q000187:drug effects*; D004576:Electromyography / Q000187:drug effects; D004594:Electrophysiology; D005260:Female; D006181:H-Reflex / Q000187:drug effects; D006801:Humans; D007592:Joint Diseases / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000187:drug effects / Q000502:physiology; D010525:Peripheral Nerves / Q000187:drug effects*; D012026:Reflex, Stretch / Q000187:drug effects
D009125:Muscle Relaxants, Central; D001418:Baclofen