Spasticity commonly causes a 'stiffness' or 'tightness' in the already weakened muscles of a person with amyotrophic lateral sclerosis (also known as motor neuron disease). This can lead to even greater difficulties in the ability to perform day-to-day activities. This review found only one randomized trial of treatment for spasticity in motor neuron disease. The trial was too small to determine whether individualised moderate intensity endurance type exercises for the trunk and limbs are beneficial or harmful. No other trials of different treatments or therapies were found. Further research is needed to determine if exercise or other therapies such as anti-spasticity medication are beneficial or harmful.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 7, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Ashworth NL, Satkunam LE, Deforge D. Treatment for spasticity in amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004156. DOI: 10.1002/14651858.CD004156.pub3

Editorial Group: Neuromuscular Disease Group

This version first published online: January 26. 2004
Last assessed as up-to-date: April 29. 2008

Abstract

Background

Spasticity commonly affects patients with motor neuron disease. It is likely to contribute to worsening muscle dysfunction, increased difficulty with activities of daily living and deteriorating quality of life.

Objectives

The objective of this review is to systematically review treatments for spasticity in amyotrophic lateral sclerosis, also known as motor neuron disease.

Search strategy

We searched the Cochrane Neuromuscular Disease Group trials register (January 2003, January 2005, April 29 2008), MEDLINE (January 1966 to April 29 2008), EMBASE (January 1980 to April 29 2008), CINAHL (January 1982 to April 29 2008), AMED (January 1985 to April 29 2008) and LILACS (January 1982 to April 29 2008). We reviewed the bibliographies of the randomized controlled trials identified, and contacted authors and experts in the field.

Selection criteria

We included quasi-randomized or randomized controlled trials of participants with probable or definite amyotrophic lateral sclerosis according to the El Escorial diagnostic criteria (or a revised version) or the Airlie House revision. We would have included trials of physical therapy, modalities, prescription medications, non-prescription medications, chemical neurolysis, surgical interventions, and alternative therapies. Our primary outcome measure was reduction in spasticity at three months or greater as measured by the Ashworth (or modified Ashworth) spasticity scale. Our secondary outcome measures were: validated measures based on history, physical examination, physiological measures, measures of function, measures of quality of life, serious adverse events, and measures of cost.

Data collection and analysis

We identified only one randomized controlled trial that met our inclusion criteria. Two authors extracted the data. We also contacted the author of the paper and obtained information not available in the published article.

Main results

The included study was a trial of moderate intensity, endurance type exercise versus 'usual activities' in 25 patients with amyotrophic lateral sclerosis. At three months patients performing the 15 minute twice daily exercises had significantly less spasticity overall (mean reduction of -0.43, 95% CI -1.03 to +0.17 in the treatment group versus an increase of +0.25, 95% CI -0.46 to +0.96 in control) but the mean change between groups was not significant (-0.68, 95% CI -1.62 to +0.26), as measured by the Ashworth scale.

Authors' conclusions

The single trial performed was too small to determine whether individualised moderate intensity endurance type exercises for the trunk and limbs are beneficial or harmful. No other medical, surgical or alternative treatment and therapy has been evaluated in a randomized fashion in this patient population. More research is needed.

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