Gabapentin for relief of upper motor neuron symptoms in multiple sclerosis

Objective: To examine the efficacy of gabapentin in the treatment of spasticity and painful muscle spasms in patients with multiple sclerosis. Design: Double-blind, placebo-controlled crossover study. Setting: Free-standing, 93-bed, university-affiliated rehabilitation hospital. Participants: There were 15 patients between the ages of 18 and 50 who had laboratory-supported definite multiple sclerosis with spasticity and leg cramps severe enough to interfere with daily activities, including sleep. Intervention: The patients received the placebo or 400mg gabapentin orally three times a day for 48 hours with an 11-day washout period. If the patients were on currently accepted modes of therapy, including oral baclofen, their current medication was not changed. Main Outcome Measures: The outcome measures were Visual Faces Scale rating, Kurtzke Disability Scale, quantitative surface electromyography, Ashworth Scale, presence or absence of clonus in response to rapid ankle dorsiflexion and wrist extension, presence or absence of reflex withdrawal in response to nailbed pressure to the first finger, and assessment of Babinski response. Results: Statistically significant improvements for the gabapentin-treated patients were found in the Ashworth Scale, Visual Faces Scale, and Kurtzke Disability Scale. Conclusions: At a dose of 400mg orally three times a day, gabapentin may be of value in the treatment of the spasticity and painful muscle cramping experienced by patients with multiple sclerosis.