Gabapentin effect on spasticity in multiple sclerosis: a placebo-controlled, randomized trial.
OBJECTIVE
To investigate the effect of gabapentin on subject self-report and physician-administered spasticity scales in individuals with multiple sclerosis.


METHODS
Prospective, double-masked, placebo-controlled, crossover design.


METHODS
The Multiple Sclerosis Center at the Denver Veterans Affairs Medical Center.


METHODS
Subjects were titrated to either 900 mg gabapentin orally three times a day or placebo over a 6-day period. Subjects underwent a 14-day washout and then were crossed over. No other changes were made to their medication regimen.


METHODS
The outcome measures were divided into two categories: subject self-report scales physician-administered scales. Subject self-report scales included the spasm frequency scale, spasm severity scale, interference with function scale, painful spasm scale, and global assessment scale. Physician-administered scales included the Modified Ashworth Scale, clonus scale, deep tendon reflexes, plantar stimulation response, and the Kurtzke Expanded Disability Status (EDSS) Scale. Digit Span and Digit Symbol subtests of the WAIS-R Intelligence Scale were administered to assess for possible impaired concentration. The Fatigue Impact Scale was administered to assess for changes in fatigue. The adjective generation technique was administered to assess for alterations in mood.


RESULTS
A statistically significant reduction in the impairment of spasticity was found in the gabapentin-treated subjects compared with placebo as measured by the self-report scales of the spasm severity scale, interference with function scale, painful spasm scale, and global assessment scale and by the physician-administered scales of the Modified Ashworth and plantar stimulation response. No significant difference was noted in the Digit Span, Digit Symbol, adjective generation technique, and EDSS.


CONCLUSIONS
Gabapentin reduces the impairment of spasticity, compared with placebo, without the side effects of worsening concentration and fatigue.
Cutter
N C
NC
University of Colorado Health Sciences Center, Denver, USA.
Scott
D D
DD
Johnson
J C
JC
Whiteneck
G
G
D000085:Acetates / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000588:Amines; D000927:Anticonvulsants / Q000627:therapeutic use*; D018592:Cross-Over Studies; D003509:Cyclohexanecarboxylic Acids; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation; D018763:Muscle Fatigue / Q000187:drug effects; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D011446:Prospective Studies; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin