What are the second-line treatments for spasticity in amyotrophic lateral sclerosis (ALS)?

Updated: Jan 02, 2020
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Ryan O Stephenson, DO  more...
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Answer

Answer

Patients with amyotrophic lateral sclerosis (ALS) who have severe, generalized spasticity resulting in pain or impaired function may initially be given oral medications discussed previously; however, if these medications are ineffective or poorly tolerated at higher doses, consider referral for placement of an intrathecal baclofen pump.

Patients with severe spasticity limited to specific muscle groups may be treated with isolated nerve or motor point blocks, using phenol or botulinum toxin. The type of block generally used is based on the size of the muscle groups involved, risk of paresthesias with phenol injections, cost, and physician preference.


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