title: Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper.
abstract: Treatment of spasticity poses a major challenge given the complex clinical presentation and variable efficacy and safety profiles of available drugs. We present a systematic review of the pharmacological treatment of spasticity in multiple sclerosis (MS) patients.
  
  
  
  Controlled trials and observational studies were identified. Scientific evidence was evaluated according to pre-specified levels of certainty.
  
  
  
  The evidence supports the use of baclofen, tizanidine and gabapentin as first-line options. Diazepam or dantrolene could be considered if no clinical improvement is seen with the previous drugs. Nabiximols has a positive effect when used as add-on therapy in patients with poor response and/or tolerance to first-line oral treatments. Despite limited evidence, intrathecal baclofen and intrathecal phenol show a positive effect in severe spasticity and suboptimal response to oral drugs.
  
  
  
  The available studies on spasticity treatment offer some insight to guide clinical practice but are of variable methodological quality. Large, well-designed trials are needed to confirm the effectiveness of antispasticity agents and to produce evidence-based treatment algorithms.
authors.affiliation: Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain/Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain sotero@cem-cat.org.
authors.forename: Susana
authors.initials: S
authors.lastname: Otero-Romero
authors.affiliation: Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Sastre-Garriga
authors.affiliation: Neurological Department, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Comi
authors.affiliation: Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Hartung
authors.affiliation: Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Soelberg Sørensen
authors.affiliation: Department of Brain Repair & Rehabilitation, Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Thompson
authors.affiliation: Université Lille, INSERM, CHU Lille, Lille Inflammation Research International Center (LIRIC) UMR 995, Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vermersch
authors.affiliation: Department of Neurology, Ruhr University, St. Josef-Hospital, Bochum, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
authors.affiliation: Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Montalban
mesh_terms: D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D001418:Baclofen / Q000627:therapeutic use; D002185:Cannabidiol / Q000627:therapeutic use; D003000:Clonidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003620:Dantrolene / Q000627:therapeutic use; D003975:Diazepam / Q000627:therapeutic use; D013759:Dronabinol / Q000627:therapeutic use; D004338:Drug Combinations; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D000077206:Gabapentin; D006801:Humans; D007278:Injections, Spinal; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy*; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D019800:Phenol / Q000627:therapeutic use; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D004338:Drug Combinations; D018691:Excitatory Amino Acid Antagonists; D009125:Muscle Relaxants, Central; D002185:Cannabidiol; D019800:Phenol; D005680:gamma-Aminobutyric Acid; C023754:tizanidine; D000077206:Gabapentin; D013759:Dronabinol; D003620:Dantrolene; D001418:Baclofen; C587251:nabiximols; D003000:Clonidine; D003975:Diazepam
keywords: Multiple sclerosis; pharmacological treatment; review; spasticity