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Oral dantrolene is contraindicated for [13] patients with active hepatic disease; patients in whom spasticity is utilized to maintain upright posture and balance; patients with a hypersensitivity to dantrolene; There are no contraindications for intravenous dantrolene used for prophylaxis or management of malignant hyperthermia. [14]
Dantrolene remains the only drug known to be effective in the treatment of MH. [30] The recommended dose of dantrolene is 2.5 mg/kg, repeated as necessary. [5] It is recommended that each hospital keeps a minimum stock of 36 dantrolene vials (720 mg), sufficient for four doses in a 70-kg person. [36]
Baclofen, diazepam and dantrolene remain the three most commonly used pharmacologic agents in the treatment of spastic hypertonia. Baclofen is generally the drug of choice for spinal cord types of spasticity, while sodium dantrolene is the only agent which acts directly on muscle tissue. Tizanidine is also available.
Dantrolene, although thought of primarily as a peripherally acting agent, is associated with CNS effects, whereas baclofen activity is strictly associated with the CNS. Muscle relaxants are thought to be useful in painful disorders based on the theory that pain induces spasm and spasm causes pain.
[70] Natalizumab is considered highly effective in terms of relapse rate reduction and halting disability progression, however, it is considered a second-line treatment because of the risk of adverse side-effects. [36] Natalizumab halves the risk of relapsing when compared to interferons, having an overall efficacy of over 70%. [36]
Drugs such as baclofen, benzodiazepines (e.g., diazepam), tizanidine, and sometimes dantrolene have shown promise in the effort to diminish spasticity. [10] Botulinum toxin ("Botox") type A may reduce spasticity a few months at a time and has frequently been considered a beneficial treatment for children with SHCP and other forms of CP. [5]
A physiotherapist can help to reduce spasticity and avoid the development of contractures with techniques such as passive stretching. [125] There is evidence, albeit limited, of the clinical effectiveness of THC and CBD extracts, [126] baclofen, [127] dantrolene, [128] diazepam, [129] and tizanidine.
Spasm may also be seen in movement disorders featuring spasticity in neurologic conditions such as cerebral palsy, multiple sclerosis, and spinal cord disease. Medications are commonly used for spastic movement disorders, but research has not shown functional benefit for some drugs.
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