Multiple Sclerosis Spasticity Management

Initial management

Exclude contributing factors (e.g. pain, urinary retention, infection, constipation, pressure sores etc).

1st line

• Baclofen 5mg tds, increased as required / tolerated to 20mg tds.

2nd line

• Tizanidine 2mg od, increased as required/tolerated to max 8mg tds.

Other options

• Gabapentin (300mg, increased as required/tolerated to 900mg tds, usual dose 600mg bd/tds)
• Dantrolene (25mg daily, increased as required/tolerated to 100mg qds, usual dose 75mg tds)
• Diazepam – may be helpful adjunct as required if reflex spasms with movement or in nocturnal spasms
• Cannabinoids (e.g. Sativex): Sativex can only be considered in those with moderate to severe spasms resistant to 1st line therapies (i.e. Baclofen and Tizanidine).

There is a physiotherapy-led spasticity service, based in RVH, for ongoing spasticity management.