Multiple Sclerosis: Medicines for Muscle Stiffness and Tremors
Topic Overview
Spasticity
Several medicines may be used to treat
muscle stiffness (spasticity) caused by
multiple sclerosis (MS).
- Baclofen (Lioresal) is the drug of choice for
spasticity. It is available in tablets or by delivery through a pump implanted
in the lower spinal area. Pump delivery is effective for those with severe
spasticity.
- Tizanidine (Zanaflex) is a drug similar to baclofen. It
is available in tablet form.
- Dantrolene (Dantrium) is also
effective. But it may cause muscle weakness, which limits the number of
people who can use it. Other side effects may include nausea, vomiting, lack of
hunger (anorexia), and, with high dosages or prolonged use, liver
damage.
- Gabapentin (Neurontin) may help relieve pain as well as
spasticity. It is usually very well tolerated and causes few side
effects.
- Diazepam (Valium) and clonazepam (Klonopin) relieve both
spasticity and anxiety but may cause side effects such as dizziness,
drowsiness, and confusion.
Often a combination of these medicines given in small
doses is better tolerated and more effective than a larger dose of a single
medicine.
Some people try alternative therapy. One study found
that 97% of people who used marijuana reported improvement in spasticity and
tremor.1 In some cases, injection of botulinum toxin
(Botox) may provide relief.2
Tremor
Carbamazepine (Tegretol), which is a seizure
medicine, benzodiazepines such as diazepam (Valium) and clonazepam
(Klonopin), and beta-blockers, especially propranolol (Inderal), may have some
benefit in treating
tremors caused by MS.
Severe tremors are
very hard to treat. If they do not respond to medicine, surgery may be
needed.
The U.S. Food and Drug Administration (FDA) has issued a
warning on seizure medicines and the risk of suicide and suicidal thoughts. The
FDA does not recommend that people stop using these medicines. Instead, people
who take seizure medicine should be watched closely for
warning signs of suicide. People who take seizure
medicine and who are worried about this side effect should talk to a
doctor.
References
Citations
- Krupp LB, Rizvi SA (2002). Symptomatic therapy for
underrecognized manifestations of multiple sclerosis. Neurology: Practical Issues in the Management of Multiple Sclerosis, 58(Suppl 4): S32–S39.
- Simpson DM, et al. (2008). Assessment: Botulinum neurotoxin for the treatment of spasticity (and evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1691–1698.
Credits
| By | Healthwise Staff |
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| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
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| Primary Medical Reviewer | Adam Husney, MD, MD - Family Medicine |
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| Specialist Medical Reviewer | Colin Chalk, MD, CM, FRCPC - Neurology |
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| Last Revised | February 18, 2010 |
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Last Revised:
February 18, 2010
Krupp LB, Rizvi SA (2002). Symptomatic therapy for
underrecognized manifestations of multiple sclerosis. Neurology: Practical Issues in the Management of Multiple Sclerosis, 58(Suppl 4): S32–S39.
Simpson DM, et al. (2008). Assessment: Botulinum neurotoxin for the treatment of spasticity (and evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1691–1698.
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