ГоловнаArchive of numbers2020Volume 28, issue 4 (105)Evaluation of the effect of antispastic therapy in patients with multiple sclerosis based on the results of clinical and neurofunctional, neurophysiological and neuropsychological studies
Title of the article Evaluation of the effect of antispastic therapy in patients with multiple sclerosis based on the results of clinical and neurofunctional, neurophysiological and neuropsychological studies
Authors Domres Nataliia
Year 2020 Issue Volume 28, issue 4 (105) Pages 18-24
Type of article Scientific article Index UDK 616.832-004.2 -073.756.8:612.66 Index BBK -

Objective: to conduct a comprehensive clinical and instrumental assessment of the effectiveness of antispastic therapy in multiple sclerosis patients. The observation of 68 patients with multiple sclerosis. The patients took three antispastic drugs — baclofen, thiocolchicoside (muscomed), tolperisone (midocalm). The degree of neurological deficit was assessed on the EDSS scale, the level of spasticity on the Ashworth scale, an electroneuromyographic study was performed using a stimulation non-invasive technique. Patients underwent a Timed-25-Footwalk test and a 9-Hole Peg Test. Patients completed questionnaires to assess quality of life (EuroQol-5D), fatigue (MFIS), pain (VAS). The assessment was carried out before treatment, after 10 days and after 2 months. In the group of patients who took thiocolchicoside, the total spasticity score was 12.87 ± 3.35, tolperisone — 14.17 ± 3.99, baclofen — 17.03 ± 3.74. 10 days after treatment, the total spasticity score decreased in all groups of patients. In the thiocolchicoside group the EDSS before treatment was 5.15 ± 0.88, tolperisone — 5.05 ± 0.63, baclofen — 5.68 ± 0.82. The effect size was strong in Cohen and Glass. After 10 days, the average EDSS score in the group of patients taking thiocolchicoside was 5.06 ± 0.85, tolperisone — 4.98 ± 0.56, baclofen — 5.55 ± 0.79 (p < 0.05). Ambulation scores were significantly improved in three groups of patients, which influenced the EDSS score. The studied drugs reliably reduce spasticity and improve the quality of life of patients, improve stroke rates, reduce fatigue and pain, test scores T25-FW, 9-HPT, the effect of treatment was stable during 2 months. Effect size measures were strong in total spasticity. When using thiocolchicoside, the M-amplitude indicator significantly increases in patients.
Key words multiple sclerosis, spasticity, EDSS, M-amplitude
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1. Zavalishin, I. A., Barkhatova, V. P., & Shitikova, I. E. (2000). Spasicheskiy parez [Spastic paresis]. Rasseyannyi Skleroz [Multiple Sclerosis], 436–455
2. Patejdl R., Zettl U. K. Spasticity in multiple sclerosis: Contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions // Autoimmun Rev. 2017. Vol. 16(9). P. 925—936. DOI: 10.1016/j.autrev.2017.07.004.
3. Beer S. Management of spasticity in multiple sclerosis (MS) // MS Alumni Programme, 2014. URL: https://www.excemed.org/ms-alumni/resources/management-spasticity-multiple-sclerosis-ms.
4. A randomized, double-blind, placebo-controlled study of the efficacy and safety of tolperisone in spasticity following cerebral stroke / Stamenova P., Koytchev R., Kuhn K. [et al.] // European journal of neurology. 2005. Vol. 12 (6). P. 453—461. DOI: https://doi.org/10.1111/j.1468-1331.2005.01006.x. 5. Khatkova S.E., Akulov M.A. (2018). Efficacy of Botulinotherapy in the Treatment of the Lower Limb Spasticity, Pharmateca, №s2, 45–53. https://dx.doi.org/10.18565/pharmateca.2018.s2.45-53.
6. Gusev, E. I., Gekht, A. B. (1999). Spastichnost [Spasticity]. Russkiy Meditsinskiy Zhurnal [Russian Medical Journal], 7(12), 45–47.
7. Kamchatnov, P. R. (2004). Spastichnost — sovremennye podkhody k terapii [Spasticity — modern approaches to therapy]. Russkiy Meditsinskiy Zhurnal [Russian Medical Journal], 14, 849.
8. Balantrapu S., Sandroff B. M., Sosnoff J. J. Perceived Impact of Spasticity Is Associated with Spatial and Temporal Parameters of Gait in Multiple Sclerosis // ISRN Neurology. 2012. Article ID 675431, 6 pages. DOI: 10.5402/2012/675431.
9. Spasticity in multiple sclerosis: Associations with impairments and overall quality of life / Milinis, K., Tennant, A., Young, C. A., & TONiC study group // Multiple Sclerosis and Related Disorders. 2016. Vol. 5. P. 34—39. DOI: https://doi.org/10.1016/j.msard.2015.10.007.
10. Shakespeare D., Craig J., Lloyd M. Spasticity and Movement // International MS Journal. 2001. Vol. 7(3). P. 93—99.
11. Schapiro R. T. Managing the Symptoms of Multiple Sclerosis, 5th edition. Demos Medical Publishing. 2007.
12. Bowden M., Stokic D. J. Clinical and Neurophysiologic Assessment of Strength and Spasticity During Intrathecal Baclofen Titration in Incomplete Spinal Cord Injury: Single-Subject Design // The Journal of Spinal Cord Medicine. 2009. Vol. 32(2). P. 183—190. DOI: https://doi.org/10.1080/10790268.2009.11760770.
13. Traitement par Baclofen intrathécal de la spasticité et des spasmes en flexion/extension des lésions médullaires / Azouvi, P.; Biraben, A.; Bussel, B. [et al.] // Annales de réadaptation et de médecine physique. 1991. Vol. 34(2). P. 143—149. URL: http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=5104905.
14. Sue K., Brandfass K. Spasticity // Clinical Bulletin National MS Society. 2008. Vol. 5. P. 4—14. URL: https://secure.nationalmssociety.org/docs/HOM/clinicalbulletin_spasticity.pdf.
15. Feldman R. G., Kelly-Hayes M., Conomy J. P., Foley J. M. Baclofen for spasticity in multiple sclerosis. Double-blind crossover and threeyear study // Neurology. 1978. Vol. 28(11). P. 1094—1098. DOI: https://doi.org/10.1212/wnl.28.11.1094.
16. Pinto O. D., Polker M., Debono G. Results of international clinical trials with Lioresal // Postgraduate medical journal. 1972. Vol. 48 (Suppl5). P. 18—23.
17. Cartlidge N. E., Hudgson P., Weightman D. A comparison of baclofen and diazepam in the treatment of spasticity // J Neurol Sci. 1974. Vol. 23. P. 17—24. DOI: https://doi.org/10.1016/0022-510x(74)90137-3.
18. Symptomatic therapy in multiple sclerosis / Frohman T. C., Castro W., Shah A., Courtney A. [et al.]// Ther Adv Neurol Disord. 2011. Vol. 4. P. 83—98. DOI: https://doi.org/10.1177/1756285611400658.
19. Sachais B. A., Logue J. N., Carey M. S. Baclofen, a new antispastic drug. A controlled, multicenter trial in patients with multiple sclerosis // Archives of neurology. 1977. Vol. 34. P. 422—428. DOI: https://doi.org/10.1001/archneur.1977.00500190056008.
20. Basmajian J. V. Lioresal (baclofen) treatment of spasticity in multiple sclerosis // Am J Phys Med. 1975. Vol. 54. P. 175—177. PMID: 1098477. URL: https://pubmed.ncbi.nlm.nih.gov/1098477/.
21. Nielsen J. F., Anderson J. B., & Sinkjaer T. Baclofen increases the soleus stretch reflex threshold in the early swing phase during walking in spastic multiple sclerosis patients // Multiple sclerosis (Houndmills, Basingstoke, England). 2000. Vol. 6(2). P. 105—114. DOI: https://doi.org/10.1177/135245850000600209.
22. Nielsen J. F., Sinkjaer T. Peripheral and central effect of baclofen on ankle joint stiffness in multiple sclerosis // Muscle & nerve. 2000. Vol. 23. P. 98—105.
23. Walking improvements with nabiximols in patients with multiple sclerosis / Coghe G., Pau M., Corona F. [et al.] // J. Neurol. 2015. Vol. 262(11). P. 2472—2477. DOI: https://doi.org/10.1007/s00415-015-7866-5.
24. Orsnes G. B., Sørensen P. S., Larsen T. K., Ravnborg M. Effect of baclofen on gait in spastic MS patients // Acta neurologica Scandinavica. 2000. Vol. 101. P. 244—248. DOI: 10.1034/j.1600-0404.2000.101004244x./.
25. Spasticity Management in Multiple Sclerosis. Evidence-Based Management Strategies for Spasticity Treatment in Multiple Sclerosis : Clinical Practice Guideline / P. Haselkorn, R. C. Balsdon, W. D. Fry [et al.] // The Journal of Spinal Cord Medicine. 2005. Vol. 28, Issue 2. P. 173–199. DOI: https://www.tandfonline.com/doi/abs/10.1080/10790268.2005.11754545.
26. Dulin J., Kovács L., Ramm S. Evaluation of sedative effects of single and repeated doses of 50 mg and 150 mg tolperisone hydrochloride // Pharmacopsychia. 1998. Vol. 31. P. 137—142. DOI: https://doi.org/10.1055/s-2007-979315.
27. Tekes K. Basic Aspects of the Pharmacodynamics of Tolperisone, A Widely Applicable Centrally Acting Muscle Relaxant // The Open Medicinal Chemistry Journal. 2014. Vol. 8. P. 17—22. DOI: https://doi.org/10.2174/1874104501408010017.
28. Pratzel H. G., Alken R. G., Ramm S. Efficacy and tolerance of repeated oral doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebo-controlled double-blind trial // Pain. 1996. Vol. 67(2—3). P. 417—425. DOI: https://doi.org/10.1016/0304-3959(96)03187-9.
29. Prophylactic tolperisone for post-exercise muscle soreness causes reduced isometric force — a double-blind randomized crossover control study / Bajaj P., Arendt-Nielsen L., Madeleine P., Svensson P. // Eur J Pain. 2003. 7(5). P. 407—418. DOI: https://doi.org/10.1016/S1090-3801(02)00145-3.
30. Garg T., Yadav V. K. A comparative study on safety and efficacy of tolperisone with etodolac and thiocolchicoside with etodolac in patients of acute low back pain with musculoskeletal spasm // Int J Basic Clin Pharmacol. 2019. Vol. 8, No. 11. P. 2459—2464. DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20194784.
31. Clinical comparative study: efficacy and tolerability of tolperisone and thiocolchicoside in acute low back pain and spinal muscle spasticity / Rao R., Panghate A., Chandanwale A. [et al.] // Asian spine journal. 2012. Vol. 6(2). P. 115—122. DOI: https://doi.org/10.4184/asj.2012.6.2.115.
32. Tabtimsuwan S., Sitthinamsuwan B., Chankaew E. Spasticity: A comprehensive review // Siriraj Medical Journal. 2011. Vol. 63. P. 32—37. URL: https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/240897.
33. Flachenecker P., Henze T., Zettl U. K. Spasticity in patients with multiple sclerosis — clinical characteristics, treatment and quality of life // Acta Neurol. Scand. 2014. Vol. 129(3). P. 154—162. DOI: https://doi.org/10.1111/ane.12202.
34. Alonso A., Hernan M. A. Temporal trends in the incidence of multiple sclerosis: a systematic review // Neurology. 2008. Vol. 71. P. 129—135. DOI: https://doi.org/10.1212/01.wnl.0000316802.35974.34.
35. Spasticity in Multiple Sclerosis / Barnes M. P. Kent R. M., Semlyen J. K. [et al.] // Neurorehabilitation and Natural Repair. 2003. Vol. 17. P. 66—67. DOI: https://doi.org/10.1177/0888439002250449.
36. Izquierdo G. Multiple sclerosis symptoms and spasticity management: new data // Neurodegener. Dis. Manag. 2017. Vol. 7(6s). P. 7—11. DOI: https://doi.org/10.2217/nmt-2017-0034.