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MS – Nocturnal Spasms Management — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – Nocturnal Spasms ManagementSCE Neurology

A man with multiple sclerosis has painful extensor spasms that impair transfers. Infection, urinary retention, constipation, pressure injury, positioning problems and pain triggers have been addressed. Oral baclofen gives partial benefit, but somnolence prevents further dose escalation. Which next pharmacological step follows the current NICE sequence?

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Correct answer: E — Retain tolerated baclofen and add titrated gabapentin

NICE recommends oral baclofen first line for MS spasticity and gabapentin second line when baclofen is not tolerated or does not provide adequate relief. It also permits their combination when one drug gives insufficient relief or adverse effects prevent further dose escalation. Because baclofen has some benefit but somnolence limits titration, retaining the tolerated dose and cautiously adding gabapentin follows that sequence. Combined central nervous system depression can cause severe respiratory depression, so dose titration and monitoring remain important. Alternative oral agents and specialist invasive treatment may be considered later, but they do not precede the specified second-line strategy here.

Reference: NICE NG220, Multiple sclerosis in adults — spasticity recommendations: https://www.nice.org.uk/guidance/ng220/chapter/recommendations