Epub: Shaygannejad et al. Comparison of the effect of baclofen and transcutaneous electrical nerve stimulation for the treatment of spasticity in multiple sclerosis. Neurol Res. 2013 Apr.
OBJECTIVE: The aim of this study was to compare the relative efficacy of baclofen and self-applied transcutaneous electrical nerve stimulation (TENS) for the treatment of spasticity in the lower extremities in MS.
METHODS: A randomized controlled clinical trial was conducted from September 2010 to June 2011. Fifty two MSers presenting muscle spasm in the leg at 20-50 years of age were randomly allocated to receive a four-week treatment course of either baclofen (10 mg twice daily, increasing over three weeks to 25 mg) or self-applied TENS. Response to treatment was assessed at four weeks after commencement of the intervention by modified Ashworth scale (MAS).
RESULTS: Spasticity decreased in both groups. Of the 26 people treated with TENS, the mean (standard deviation (SD)) MAS decreased from 1.77 (0.29) at baseline to 0.73 (0.70) at the four-week follow-up (P<0.001). Correspondingly, in the 26 people treated with baclofen, the mean (SD) MAS decreased from 1.73 (0.38) to 1.15 (0.63) (P<0.001). The mean difference in MAS score at the four-week follow-up was significantly lower in the TENS group than the baclofen group (mean difference 0.42; P<0.05).
DISCUSSION: This study demonstrates that both baclofen and TENS can be effective in reducing MS-related spasticity. The mean MAS score was significantly lower in the TENS group. However given the side-effect profile of baclofen, TENS may have some benefits over baclofen.
“This study is under-powered and the results could be explained by the regression to the mean; this occurs when you select MSers for moderate to severe spasticity and then their condition improves spontaneously. In addition, spasticity is one of the symptoms that responds particularly well to interventions including placebos. Nevertheless this study suggest TENS is better than baclofen; but is it? The dose of baclofen used is odd; baclofen has a short half-life and needs to be prescribed 3, 4 or occasionally 5 times a day. A twice daily dose of baclofen is not how we use this drug in clinical practice. We either use it more frequently than this or we only use it at night to treat nocturnal spasms. DO any of you use TENS? It would be interesting to hear how you find it.”