Table 3.

Treatment of Manifestations in Individuals with Spastic Paraplegia 8

Manifestation/
Concern		TreatmentConsiderations/Other
Spasticity Individualized PT program
  • Stretching exercises to improve flexibility, ↓ spasticity & maintain or improve joint range of motion & prevent joint contractures
  • Aerobic exercise to improve cardiovascular fitness to maintain & improve muscle strength, coordination & balance
  • Strengthening exercises to improve posture; walking; arm strength to improve use of mobility aids; activites of daily living
Reduction of spasticityMassage, ultrasound, whirlpool, anodal spinal direct current stimulation 1
Antispasmodic drugsBaclofen, botulinum toxin, dantrolene, tizanidine (used 1 at a time) 2 esp early in disease course to decrease cramps, make leg muscles less tight, & facilitate walking
Bladder function Spastic bladder symptoms: urgency, frequency, difficulty voidingTreatment can incl anticholinergics such as oxybutynin (Ditropan XL®), solifenacin (Vesicare®), and mirabegron (Myrbetriq®).
Dysphagia Gastroenterology / nutrition / feeding team evalDetermine exact cause of swallowing malfunction; modify food types & consistency, head positioning during swallowing, & exercises to improve swallowing.
Dysarthria Speech & language pathologistTo help maintain vocal control; improve speech, breathing techniques, & communication in general
Bowel function Symptoms: constipation & fecal incontinenceStool softeners
Mobility
  • Feet: appropriate footwear
  • Orthotics (shoe inserts, splints, braces) to address gait problems, improve balance, relieve &/or improve pressure sores
  • Gait training; use of assistive walking devices (e.g., canes, walker, walker w/wheels, walker w/seat, wheelchairs)
Activities of
daily living 		PT
  • Transfers (e.g., from bed to wheelchair, wheelchair to car)
  • Training how to fall to minimize risk of injury
OT
  • To accomplish tasks such as mobility, washing, dressing, eating, cooking, grooming
  • To assist w/household modifications to meet special needs
Clinical
depression 		PsychiatryPsychotherapy & SSRI
Social support Social services & support groupsTo help cope w/diagnosis

OT = occupational therapy; PT = physical therapy; SSRI = selective serotonin reuptake inhibitor

1.

Demonstrated by Ardolino et al [2018] in a randomized controlled trial.

2.

Oral baclofen can be tried first, and can also be used with an intrathecal pump in some cases. The entire therapeutic range of doses in all four drugs is used. The drugs are administered before sleep if nocturnal cramps are problematic, otherwise three to four times per day. It usually takes a few days for their effects to become evident. No significant toxicity limits their use.

From: Spastic Paraplegia 8

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