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Thread: New:Overnight Leg Issues - What is this?

  1. #11
    Member bberr's Avatar
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    Jan 2004
    Dr. Wise

    Tight quads is my major problem beside tight low backmuscles. I dont walk with a limp, but it hinders me to run and i also get spasms if i wake up during the night. However they are so mild that i can continue sleeping.I ´m also on baclofen 3 times a day 25 mg. I cant see it helps so much. I do everything to reduce the spastisity (warm baths, streching, sauna). All this gives me a temporary relaxation. Do you have any other suggestions for decreasing spastisity?

  2. #12
    Perhaps it would be useful to initiate a discussion of baclofen therapy for spasticity and spasms in spinal cord injury.

    Baclofen effectively reduces spasticity (increased muscle tone and reflexes). Although baclofen is known to stimulate a receptor called GABA-B, the mechanism by which baclofen reduces spasticity is not well understood. The drug suppresses spinal reflexes. Taken in sufficiently high doses, baclofen can weaken muscles to the point of flaccidity (no tone) and thereby reduce spasms. On the other hand, such suppression of muscle tone will lead to increased muscle atrophy (loss of muscle bulk).

    Control of spasticity and spasms is useful for several reasons. In people who have incomplete spinal cord injury or multiple sclerosis, spasticity or increased muscle reflexes can interfere with voluntary control of muscles, making it hard to walk or control one's movements. If it occurs in the upper limbs, it can reduce dexterity and speed of movement. Strong spasms can pose risks to people with spinal cord injury. Because people with spinal cord injury have weak bones, spasms that place the limbs in stressful positions can indeed cause fractures.

    Increased muscle tone can also cause a serious problem called contractures. This is the situation where certain muscles are consistently contracted due to spasticty. Over long periods, muscles may become shortened and the person may not be able to straighten out the legs. This is most common with the muscles that cause the legs to flex and hence is called "flexion contractures". This is a serious problem, particularly in children. Reversal of flexion contractures is very difficult. Baclofen can help reduce flexion contractures.

    Baclofen is not a particularly effective treatment for spasms. Spasms are spontaneous movements of limbs, as opposed to spasticity which refers to increased muscle tone or reflexes. Few people can tolerate oral doses of baclofen that are sufficient to prevent spasms. High doses of baclofen can have significant side-effects, such as fatigue (tiredness), somnolence (sleepiness), ataxia (abnormal motor control), and even respiratory depression. Most people start to get such side effects at 80-120 mg per day. Baclofen pumps can deliver sufficient drug directly to the spinal cord to cause flaccidity without these side-effects.

    People should not be afraid of Baclofen, however. It is a relatively safe drug. Millions of people have taken this drug for decades. As long as the dose is carefully titrated, it can be used to suppress spasticity without producing adverse CNS effects or muscle atrophy. The drug is rapidly absorbed and excreted unchanged by the kidney. Because the rate of absorption and secretion vary greatly among people, effective doses of baclofen for suppressing spasticity vary from as little as 10 mg four times a day to 30 mg four times per day.

    There are other ways to reduce spasticity and spasms besides baclofen. For example:
    • Clonidine and tizanidine (alpha adrenergic receptor agonists) can reduce spasticity and can be taken combination with baclofen.
    • Muscle relaxants, such as valium or other benzodiazepine drugs, activate GABA C receptors and can reduce spasticity.
    • Neurontin (a anti-epileptic drug that is frequently used to treat neuropathic pain) can reduce spasticity. Several studies have shown this and some people have reported this effect as well on this site.
    • Exercise and physical therapy (e.g. electrical stimulation of muscles, treadmill walking, standing, muscle stretching, etc.) can alter spasticity and spasms.

    It is important that people work closely with their doctors to titrate their baclofen doses to control spasticity sufficiently to improve motor control and prevent contractures, but at the same time minimize CNS side-effects and not cause muscle atrophy. Sometimes, a combination of therapies may be necessary to achieve these goals.

  3. #13
    What an education I am getting from one post - I very much appreciate your lengthy post on baclofen - and for explaining the difference between spasticity and spasms. I now understand my legs movements are spasms. The red circles on my ankles were so prominent last week all I could see was the bedsore film from rehab! I began wearing down-filled booties, then sheepskin slippers to protect my feet/ankles. Nothing worked. I put the quieter leg inside the pillowcase while the pillow rested between my feet. This seemed to work last night.

    And now, yet another question for the Good Dr. What are your thoughts about the air compression therapy described here?

  4. #14
    We use devices like the one you mentioned to prevent blood clots forming the legs of people after they are injured. This might help with swelling in the ankles and lower legs after being up in a chair for a long time. I don't think you would hurt yourself by using it as long and you don't have one leg swollen and warm to the touch (which would be a sign of a new blood clot).


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