GABAPENTIN FOR RELIEF OF SPASTICITY ASSOCIATED WITH MULTIPLE-SCLEROSIS

The use of a recently released anticonvulsant, gabapentin, in the trea tment of spasticity in two patients with multiple sclerosis is reporte d. Gabapentin was chosen because of its GABA-ergic effect and because previously reported studies have shown that it is well tolerated compa red with other GABA-mimetic medication. Satisfactory release of spasti city with significant improvement of functional outcome was noted in b oth cases. Both patients were first treated with gabapentin for one mo nth at 300 mg per day and then, with no reported side-effects, at 400 mg per day. Before treatment, spasticity (graded with modified Ashwort h Scale) in one patient was 3 for left lower and 2 for right lower lim bs, and Expanded Disability Status Scale (EDSS) was 7; ambulation was limited to a few steps with a standard walker. After two weeks of trea tment, spasticity was 2 and 1 for the left and right lower limbs, resp ectively. At three-month intervals, spasticity was +1 for left and 1 f or right lower limbs, and EDSS was 6; the patient could ambulate 75 to 100 m with a standard walker. In the second patient, spasticity befor e treatment was 2 for both lower and left upper limbs. EDSS was 5.5, a nd ambulation was confined to 100 m with a cane. Spasticity improved t o +1 in lower and 1 in left upper limbs after two weeks and to 1 and n ormal after three months. At three months, EDSS was 3 and the patient could ambulate for long distances without an assistive device. We sugg est that gabapentin can be used effectively to decrease spasticity wit hout significant side effects in patients with multiple sclerosis.