Levetiracetam for Phasic Spasticity in Multiple Sclerosis

Background: Spasticity is a common and debilitating, symptom of multiple sclerosis (MS). Current treatments are effective, but may be difficult to tolerate for many patients. Objective: To determine if levetiracetam, a second-generation antiepileptic drug, may be useful for the treatment of spasticity in MS. Methods: A retrospective medical record review of patients attending the Multiple Sclerosis Program at the University of Texas, Southwestern Medical Center at Dallas was performed. A series of 12 patients who had been treated with levetiracetam for spasticity was identified. Most of the patients were female (10/11), and the mean age was 41.0 years. The main outcome measure was a change in Penn spasm score or modified Ashworth score. Both scores are measured on a scale of 0 to 4. Results: The Penn Spasm score (a measure of phasic spasticity) was decreased for all patients following treatment with levetiracetam. The mean ± SD Penn Spasm score was 2.7±0.65 at baseline and decreased to 0.9±0.29 at follow-up. There was no change in modified Ashworth scores(a measure of tonic spasticity). Five patients reported adverse events; 1 patient discontinued treatment owing to an adverse event (edema). Three patients incidentally reported improvements in neuropathic pain. Conclusions: Levetiracetam was effective for reducing phasic spasticity but not tonic spasticity in this 12-patient case series. The drug was Well tolerated and therefore shows promise as a treatment for phasic spasticity. Large, well-controlled trials are needed to confirm these findings.