POSITIVE RESPONSE TO ORAL DIVALPROEX SODIUM (DEPAKOTE) IN PATIENTS WITH SPASTICITY AND PAIN

Divalproex sodium (DVS; Depakote) is a commonly used antiepileptic age nt that increases the levels of gamma aminobutyric acid. Spasticity fr om different causes may be due to a deficiency of inhibitory transmitt ers like gamma aminobutyric acid or an excess of excitatory neurotrans mitters. Spasticity also may be accompanied by pain. The authors admin istered DVS orally for pain and spasticity in three patients with a hi story of spinal cord injury and one patient with a history of head inj ury. Three patients had marked improvement in spasticity and pain. One patient, who had some symptomatic improvement in spasticity, could no t tolerate DVS because of gastric irritation. In contrast to the side effects of sedation and increased motor weakness associated with antis pasticity drugs commonly used, no such side effects were detected with DVS. It is suggested that a possible enhancement by DVS of gamma amin obutyric acid-ergic postsynaptic inhibition of motor reflex are in the spinal cord may represent a new nonsedating, management approach for spasticity as a result of traumatic spinal cord and head injuries.