Transcutaneous electrical nerve stimulation versus baclofen in spasticity: clinical and electrophysiologic comparison.
OBJECTIVE
Clinical and electrophysiologic comparison of the efficacy of transcutaneous electrical nerve stimulation (TENS) and oral baclofen in the treatment of spasticity.


METHODS
Patients with spinal cord injury and spasticity were included in the study. Ten patients were assigned to oral baclofen and 11 to TENS groups. For the comparison of H-reflex variables, 20 healthy individuals were allocated to a control group. TENS was applied to the tibial nerve for 15 days at a frequency of 100 Hz. Clinical (spasm frequency scale, painful spasm scale, lower limb Ashworth score, clonus score, deep tendon reflex score, plantar stimulation response score) and electrophysiologic evaluations (H-reflex response at the highest amplitude, latency of maximum H-reflex, and ratio of H-reflex response at the highest amplitude to M response at maximum amplitude) of the lower limb and functional evaluations (functional disability score and FIM) were carried out in baclofen and TENS groups before and after treatment. Posttreatment evaluation was made 24 hrs after the 15th session in the TENS group. In addition, clinical spasticity scores and electrophysiologic variables were measured 15 mins after the first application and 15 mins after the 15th session.


RESULTS
Significant improvement was detected in lower limb Ashworth score, spasm frequency scale, deep tendon reflex score, functional disability score, and FIM in the baclofen (P = 0.011, P = 0.014, P = 0.025, P = 0.004, and P = 0.005, respectively) and TENS (P = 0.020, P = 0.014, P = 0.025, P = 0.003, and P = 0.003, respectively) group after treatment. Decrease in H-reflex maximum amplitude was significant in the TENS group (P = 0.026). Most marked improvement was observed in the third evaluation, 15 mins after the 15th session, particularly in lower limb Ashworth score (P = 0.006) and H-reflex maximum amplitude (P = 0.006) in the TENS group. The percentage change in clinical, electrophysiologic, and functional variables caused by baclofen was not different from that caused by repeated applications of TENS in the short- and long-term evaluations (P > 0.05).


CONCLUSIONS
TENS may be recommended as a supplement to medical treatment in the management of spasticity.
Aydin
Gülümser
G
Department of Physical Medicine and Rehabilitation, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey.
Tomruk
Serap
S
Keleş
Işik
I
Demir
Sibel Ozbudak
SO
Orkun
Sevim
S
D000328:Adult; D001418:Baclofen / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D018755:GABA Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006181:H-Reflex / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology; D004561:Transcutaneous Electric Nerve Stimulation
D018755:GABA Agonists; D009125:Muscle Relaxants, Central; D001418:Baclofen