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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.
  • Injection of botulinum toxin (Botox) may provide relief in some cases.footnote 1

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 forms of natural or man-made substances related to marijuana, called cannabinoids, may help relieve spasticity.

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.

Related Information

References

Citations

  1. 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.

Other Works Consulted

  • Koppel B, et al. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic conditions. Neurology, 82(17): 1556-1563. DOI: http://dx.doi.org/10.1212/WNL.0000000000000363. Accessed January 12, 2016.
  • Yadav V, et al. (2014). Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(12): 1083-1092.

Credits

ByHealthwise Staff
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Anne C. Poinier, MD - Internal Medicine
Martin J. Gabica, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerKarin M. Lindholm, DO - Neurology

Current as ofFebruary 16, 2018


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