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ALS Worldwide
1800 North Prospect Avenue, Suite 4B
Milwaukee, WI 53202

ALS Worldwide
February 02, 2015

Anti-Spasmodic Medications

"ALS Worldwide helped me gain access to helpful medications and introduced me to treatments that drastically reduced my painful muscle cramps. As a result, I sleep much better at night and I have much more enjoyable days."

Aaron Mattox
Kentucky, USA

ALS/MND patients frequently experience upper motor neuron symptoms such as rigidity (excessive stiffness), spasticity (exaggerated stretch reflex), hyperreflexia (overactive, exaggerated reflexes)  and clonus (extended spasticity, mainly in ankle, knee cap, biceps and triceps). Anti-spasmodic medications tizanidine, baclofen, and quinine sulfate can help to alleviate these symptoms. As with all medications recommended, discussed or considered for use by those with ALS/MND, these should be carefully discussed with the patient's neurologist and/or primary care physician prior to any consideration of use.

Tizanidine, also known as Zanaflex, is a muscle relaxant that works by blocking nerve impulses (pain sensations) sent to the brain, thus temporarily relaxing muscle tone. Its absence of severe side effects causes many to feel it is superior to baclofen (see below). Dosage can be anywhere from 2-10 mg daily. ALS Worldwide feels it is the best of anti-spasmodic options, in general, for those with ALS/MND. Side effects can include dizziness, weakness, constipation and other effects.

Baclofen, also known as Gablofen, relieves spasticity by relaxing the body’s muscles. It is particularly effective in conjunction with assisted or unassisted range of motion physical therapy. However, baclofen dosing must be closely monitored to avoid limb and torso weakness, which can occur if a high dose, such as 40 to 80 mg, is prescribed too soon. Withdrawal from baclofen must be carefully monitored to avoid hallucinations, insomnia, nausea, anxiety and other adverse effects.

Quinine sulfate, also known as Qualaquin, is also suggested because it is effective for upper motor neuron symptoms such as rigidity and spasticity.  It appears to be at least as effective as baclofen as an anti-spasmodic medication and is available in 324 mg capsules available through compounding pharmacies and taken 1-2 times per day. It is primarily used when tizanidine and/or baclofen are not successful for those with ALS/MND. Adverse effects can be allergic reaction, thrombosis or renal impairment. 

Massage therapy, in addition to the medications described above, can help increase mobility, ease pain, minimize upper motor neuron muscle pain and cramping, increase circulation and reduce anxiety. Massage therapy must always be done by those with ALS/MND experience and recommended by a physician or other qualified resource. 

It is very important that every patient considering these medications have a thorough discussion with their primary physician or neurologist to assess whether the treatment in consideration is appropriate. All are prescription medications that must be prescribed by a physician.

If you or your physician have any questions or would like to discuss our viewpoints regarding these medications, please email us at [email protected]