title: Retrospective observational study of the management of multiple sclerosis patients with resistant spasticity in Spain: the '5E' study.
abstract: BACKGROUND
  Multiple sclerosis spasticity (MSS) is a common and disabling symptom for which a number of antispastic agents are available; however, evidence-based guidelines for optimal management are lacking.
  
  
  OBJECTIVE
  This retrospective observational assessment investigated the current management approach for resistant MSS in Spain. Secondary objectives were to evaluate the evolution of MSS and to estimate the social and health-related costs of managing MSS in the Spanish healthcare system.
  
  
  METHODS
  A retrospective analysis was performed using case records from 212 MS patients with spasticity that were resistant to ≥ 1 previous therapy. Data were collected over 1-3 years (mean 2.1 years), including: sociodemographics, medical history, clinical scores and all therapy/other resources consumed (e.g., rehabilitation and carers' time). Disease progression was estimated from the evolution of recorded clinical scales, and an analysis of costs from a Spanish healthcare and social perspective was performed.
  
  
  RESULTS
  The majority of patients were female and most had secondary progressive MS. Baclofen (76-80%), tizanidine and benzodiazepines were the most common antispastic drugs administered. A variety of spasticity rating scales were employed, and they demonstrated the same general trends. MS progressed, with the composite score for spasticity and mobility deteriorating in 46.4% of patients, and there were no marked differences between antispasticity drugs. The annual healthcare-related cost of treating an MSS resistant patient in the Spanish healthcare system was €15,405, largely attributable to the cost of disease-modifying drugs and care provision. Other aspects, such as medical visits and antispastic treatments, formed only a small portion of cost.
  
  
  CONCLUSIONS
  MSS progresses despite treatment with currently available antispastic agents, and it is associated with a high level of disability. Spasticity treatment represents a minor element of the overall cost of managing MSS patients in Spain. The approach to the assessment of spasticity varies between centers.
authors.affiliation: Neurology Service, Hospital Clínico San Carlos, C/ Martin Lago s/n 28040 Madrid, Spain. rafarro@terra.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Arroyo
authors.forename: Carlos
authors.initials: C
authors.lastname: Vila
authors.forename: Steve
authors.initials: S
authors.lastname: Clissold
mesh_terms: D000328:Adult; D000368:Aged; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D009128:Muscle Spasticity / Q000188:drug therapy*; D012189:Retrospective Studies