Evaluation of baclofen (Lioresal) for spasticity in multiple sclerosis.

The effect of baclofen on spasticity and muscle spasms was assessed in thirty-five patients with multiple sclerosis. Benefit from reduction of spasticity was obtained in sixteen patients. A higher proportion of patients confined to a wheelchair was helped than ambulant patients, but overall functional improvement was limited. Twenty-one of the thirty-five patients had troublesome spasms and thirteen of them had significant relief on baclofen. Substituting identical dummy tablets confirmed that benefit was attributable to the pharmacological effects of baclofen in ten of the sixteen patients whose spasticity was reduced and in eight of the thirteen whose muscle spasms were relieved. In two of the remainder, benefit appeared to be due to placebo effect, and the others maintained their improvement after stopping the drug. The drug had to be withdrawn in nine patients because of increased weakness and in ten other patients who had intolerable side effects. The optimum dose of baclofen tolerated ranged from 15 mg to 80 mg daily. The importance of adjusting the dose regime to the requirement of each individual and starting with small doses in multiple sclerosis is emphasized.