title: Long-Term Effects of Repeated Cycles of Intrathecal Triamcinolone Acetonide on Spasticity in MS Patients.
abstract: OBJECTIVE
  Spasticity is a common feature in patients with multiple sclerosis (MS). Although options have broadened over the last years, there are still patients with no response to common therapeutic agents. Intrathecal administered triamcinolone acetonide (TCA) has been tested for spasticity in patients with MS. However, the long run effects are not known so far. The aim of this study was to evaluate the effects of repeated cycles of intrathecal TCA instillations on clinical parameters.
  
  
  METHODS
  A total of 54 patients with clinically definite MS and no response to commonly utilized antispastic drugs were enrolled. TCA was administered every 3 months for a period of 9 months. Clinical assessments including spasticity, disability (EDSS), mobility (walking distance, and timed 25-foot walk), bladder function, and quality of life were carried out prior to and at the end of each treatment cycle.
  
  
  RESULTS
  Repeated TCA treatment led to repeated effects on spasticity (P < 0.01). Bladder function improved in every 10th patient. Quality of life improved during each cycle but did not reach significance at the end of study (P = 0.09). However, long-lasting improvement on spasticity or EDSS was not shown at end of the study. Effects diminished over 3 months.
  
  
  CONCLUSIONS
  Repeated TCA instillations led to replicable effects on spasticity; subgroup analyses suggest that higher spasticity, more frequent treatments, and higher EDSS may lead to pronounced effects on spasticity and EDSS. Intrathecal TCA treatment was safe and no severe side effects occurred. We hypothesize a significant time dependence of re-administration of TCA and that an interval of 3 months between the treatments might be too long.
authors.affiliation: Department of Neurology, University of Rostock, Rostock, Germany.|Department of Neurology, Medical University of Vienna, Vienna, Austria.
authors.forename: Paulus Stefan
authors.identifier: http://orcid.org/0000-0001-5209-6647
authors.initials: PS
authors.lastname: Rommer
authors.affiliation: Department of Neurology, University of Rostock, Rostock, Germany.|Department of Pathology, MVZ Hochstraße, Brandenburg an der Havel, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Kamin
authors.affiliation: Department of Neurology, University of Rostock, Rostock, Germany.|Department of Neurology, Klinikum Braunschweig, Braunschweig, Germany.
authors.forename: Mazen
authors.initials: M
authors.lastname: Abu-Mugheisib
authors.affiliation: Saechsisches Krankenhaus Hubertusburg, Wermsdorf, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koehler
authors.affiliation: Krankenhaus Martha-Maria Halle-Dölau, Halle, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Hoffmann
authors.affiliation: Department of Neurology, University of Rostock, Rostock, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Winkelmann
authors.affiliation: Department of Neurology, University of Rostock, Rostock, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Benecke
authors.affiliation: Department of Neurology, University of Rostock, Rostock, Germany.
authors.forename: Uwe Klaus
authors.initials: UK
authors.lastname: Zettl
mesh_terms: D004185:Disability Evaluation; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D001743:Urinary Bladder / Q000187:drug effects / Q000503:physiopathology; D016138:Walking
chemical_list: D007166:Immunosuppressive Agents; D014222:Triamcinolone Acetonide
keywords: Glucocortiosteroids; Intrathecal instillations; Multiple sclerosis; Spasticity; Triamcinolone acetonide