Symptomatic Treatment

These medications may be very helpful but do not address the basic autoimmune process in this chronic disorder.

BENZODIAZEPINES

Diazepam is the first-line symptomatic therapy. It was the first pharmacologic agent shown to dramatically alter the clinical course of SPS. Its use is associated with significant clinical improvement in stiffness, frequency of spasms, and ability to ambulate. Benzodiazepines are GABAa receptor agonists and thus can act to inhibit the excessive MUP firing leading to the painful muscle contraction of SPS. Common side effects include sedation, somnolence, fatigue, and ataxia. Serious side effects include hypotension, respiratory depression, and long-term physical dependence. Much caution is advised if one considers discontinuation of a benzodiazepine. This should involve a carefully monitored and very slow taper with the avoidance of an abrupt withdrawal as it can be lethal, possibly secondary to arrhythmias.

BACLOFEN

Baclofen is also considered a first-line therapy. Baclofen is a GABAB receptor agonist that also can inhibit the excessive muscle contraction of SPS. Common side effects include constipation, nausea, decreased muscle tone, headache, dizziness, and somnolence. Seizures and even death secondary may occur with abrupt withdrawal of baclofen.

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  • Category: Nervous diseases