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Spasticity Treatments After Stroke-Part 2 of 3

Oral Medication Therapy Options To Treat Spasticity After Stroke

All oral medications act systemically, that is, they affect the whole body and reduce spasticity or other abnormal movements throughout the body. They are usually mildly effective and usually more effective in young individuals than in older ones. No medication is effective for every individual.

Baclofen (Lioresal) - Baclofen is a medication quite similar to a chemical, GABA, that is deficient in people who have spasticity and is probably the most helpful and is used most often. Baclofen is usually given three times a day. When taken by mouth, a relatively small amount of baclofen gets into the spinal cord (where it needs to be to be effective. Baclofen is usually given in increasing doses up to a dose that depends on body size and weight. The medication is given in three divided doses and is increased until there is benefit, unacceptable side effects, or until a target dose is reached without benefit. The main side effect of oral baclofen is drowsiness. That side effect can be lessened if baclofen doses are started at low levels and increased slowly (e.g., every 5-14 days). Confusion and unsteadiness are less common side effects. Baclofen is not addicting and may be taken for years with minimal risk of it affecting other body organs. Baclofen is also effective in the treatment of dystonia.

Dantrolene (Dantrium) - Dantrolene is a medication used to treat spasticity. It is the only medication that acts on the muscles themselves rather than on the brain and for this reason, it causes less sedation than baclofen or diazepam although it may cause diarrhea, weakness, or a rash. Dantrolene may cause muscle weakness in high doses. Usual doses for spasticity range from 50-100 mg/day. Because Dantrolene occasionally causes liver damage, blood work is done approximately every six months to test liver function.

Tizanidine (Zanaflex) - Tizanidine is a relatively new medication that appears to be mildly effective but its use in children is often complicated by unacceptable drowsiness. Doses range from 4-24 mg/ day. Side effects include drowsiness, dizziness, and low blood pressure.

Diazepam (Valium) - Diazepam is mildly effective in reducing spasticity and athetosis. It also acts in the brain and also affects the release of GABA. Its effects last for far longer than the other medications. Unfortunately, diazepam is habituating, i.e., children who take it for several months get used to it and may require several months of slowly decreasing doses to get off of it.

Clonazepam (Klonopin) - Clonazepam is a medication similar to diazepam but has a shorted time of activity and is more easily discontinued. It may be given to treat dystonia or chorea. Doses range from 0.5 mg/twice daily to 2 mg three times a day.

Trihexiphenidyl (Artane) - This medication is frequently given to treat dystonia. It is given three times a day, beginning at perhaps 2 mg three times a day and increasing every 3-5 days up to 6-7 mg three times a day, and sometimes higher. Artane may cause dry mouth or urinary hesitancy but causes drowsiness infrequently.

L-dopa/Carbidopa (Sinemet) - This medication is often given briefly to children with dystonia for two reasons. First, there is a rare condition called dopa-responsive dystonia that may mimic CP and is dramatically improved by low doses of Sinemet. Secondly, some people with other forms of dystonia—including dystonic CP—are improved by Sinemet.

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"Spasticity is stiff or rigid muscles. It may also be called unusual "tightness" or increased muscle tone. Reflexes (for example, a knee-jerk reflex) are stronger or exaggerated. The condition can interfere with walking, movement, or speech. -National Library of Medicine"
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