Multiple Sclerosis: Medicines for Muscle Stiffness and Tremors
- Baclofen (Lioresal) is the drug of choice for spasticity. It is available in tablets or by delivery through a pump implanted in the lower spinal area. Pump delivery is effective for those with severe spasticity.
- Tizanidine (Zanaflex) is a drug similar to baclofen. It is available in tablet form.
- Dantrolene (Dantrium) is also effective. But it may cause muscle weakness, which limits the number of people who can use it. Other side effects may include nausea, vomiting, lack of hunger (anorexia), and, with high dosages or prolonged use, liver damage.
- Gabapentin (Neurontin) may help relieve pain as well as spasticity. It is usually very well tolerated and causes few side effects.
- Diazepam (Valium) and clonazepam (Clonapam, Rivotril) relieve both spasticity and anxiety but may cause side effects such as dizziness, drowsiness, and confusion.
- Injection of botulinum toxin (Botox) may provide relief in some cases.footnote 1
Often a combination of these medicines given in small doses is better tolerated and more effective than a larger dose of a single medicine.
Some forms of natural or man-made substances related to marijuana, called cannabinoids, may help relieve spasticity.
Carbamazepine (Tegretol), which is a seizure medicine, benzodiazepines such as diazepam (Valium) and clonazepam (Clonapam, Rivotril), and beta-blockers, especially propranolol (Inderal), may have some benefit in treating tremors caused by MS.
Severe tremors are very hard to treat. If they do not respond to medicine, surgery may be needed.
The U.S. Food and Drug Administration (FDA) has issued a warning on seizure medicines and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take seizure medicine should be watched closely for warning signs of suicide. People who take seizure medicine and who are worried about this side effect should talk to a doctor.
- Simpson DM, et al. (2008). Assessment: Botulinum neurotoxin for the treatment of spasticity (and evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1691-1698.
Other Works Consulted
- Yadav V, et al. (2014). Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(12): 1083-1092.
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Anne C. Poinier, MD - Internal Medicine
Andrew Swan, MD, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Barrie J. Hurwitz, MD - Neurology
Karin M. Lindholm, DO - Neurology
Current as ofOctober 9, 2017
Current as of: October 9, 2017
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