Spasticity

Gabapentin

The effect of gabapentin, an anticonvulsant developed for treating epilepsy but used mostly in the management of neuropathic pain, has been investigated as an antispastic in SCI (Clark 2002).

Author Year

Country
Research Design

Score
Total Sample Size

 Methods Outcome
Gruenthal et al. 1997

USA

RCT

PEDro=7

N=28

Population: Injury etiology: SCI=28; Chronicity: sub-acute- chronic.

Intervention: 11-day washout between 2-day gabapentin (400 mg total in 3 divided doses) or placebo with evaluations prior to, on second day within 5 hr of last dose and after washout for each treatment.

Outcome Measures: U/LE Ashworth Scale (AS), 6-point Likert ratings of spasticity, Muscle stretch reflexes, Presence or absence of ankle/wrist clonus, Reflex withdrawal to noxious stimuli in finger and foot.

1.     Gabapentin resulted in an 11% reduction in the median AS (z=2.011, p=0.044) and a 20% reduction in the median Likert Scale score (z=3.214, p=0.013) when compared to placebo.

2.     Other measures did not yield significant differences.

3.     No treatment order effect.

4.     No significant changes in any measure seen when placebo compared to baseline.

5.     No Adverse Events.

Discussion

Gruenthal et al. (1997) conducted a randomized, placebo-controlled trial and were able to reveal modest improvements as measured by Ashworth and Likert Scale scores (p=0.044 and 0.013, respectively). Despite the robust study design, no confidence intervals were reported and the sample size was relatively small.

Conclusions

There is level 1b evidence (from one RCT: Gruenthal et al. 1997) that supports the use of gabapentin for SCI-related spasticity. Despite the robust study design and validated outcome measures, no confidence intervals were reported and the sample size was relatively small.

Gabapentin may be useful in treating SCI spasticity but requires additional confirmatory research.

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