Therapy goal for muscle spasms
Prophylaxis of muscle spasms.
Therapy recommendations
- First-line agent: magnesium; if necessary, quinine sulfate (second-line agent) at night.
- Volume therapy should be given for cramps in dialysis patients.
- See also under “Further therapy“.
Therapy goal for spasticity
- Functional improvement
- Pain relief
Therapy recommendations
- Baclofen, tizanidine (mystification/antispasticity), first-line agents.
- Small studies showed a positive effect for progabide, L-dopa, clonidine* as well as cannabis (spasticity in multiple sclerosis),). The indication is usually given when there is pronounced spasticity* * and only slight impairment of voluntary motor function.
- Pronounced functional effects are not achievable with all known agents to date.
- Botulinum toxin (indications see below).
* Side effects Cinchonism: thrombocytopenia (decrease in platelets/platelets), DIC (disseminated intravascular coagulopathy), HUS (hemolytic uremic syndrome), hypersensitivity reactions, tinnitus, dizziness, gastrointestinal (nausea, vomiting, diarrhea/diarrhea); very rare (with long-term prescription): Fatal ventricular arrhythmias due to delay of repolarization in the conduction system of the myocardium, detectable by prolongation of the QT interval on ECG: mortality risk in patients < 50 years. : adjusted hazard ratio of 3.06 (2.51-3.73).
* * Tolperisone (muscle relaxants) is approved only for the treatment of poststroke spasticity in adults. Outside of this approved indication, for example, there is a risk for hypersensitivity reactions (up to and including anaphylactic shock) without proven benefit.
Indications for botulinum toxin (according to national and European consensus groups).
- Early rehabilitation for spast. Flexion tone of the arms
- Severe adductor spasticity
- Spasticity in children with kindl. Cerebral palsy → improvement of walking, standing and function of the hands.
- Spastic pointed foot/inversion, not remediable by splints, physical therapy as well as oral medication.
Other indications for botulinum toxin.
- Blepharospasm (eyelid spasm).
- Wrinkle correction
- Focal hyperhidrosis – excessive sweating on certain parts of the body.
- Spasm hemifacialis – spasm of the part of the facial muscles supplied by the facial nerve.
- Therapy-resistant spastic urinary bladder dysfunction.
- Cervical dystonia (torticollis)
Supplements (dietary supplements; vital substances)
Suitable dietary supplements should contain the following vital substances:
- Magnesium citrate
