17 msfocusmagazine.org drowsiness, to dry mouth, to liver toxicity. Discuss the potential side effects of each medication with your doctor to determine which will give you the most benefit with the least risk. Injectable Medications Botulism toxin (Botox, Dysport) has been useful when dealing with focal or localized spasticity, such as "clenched fist," seen usually with strokes. This type of treatment is unfortunately not appropriate for patients with widespread spasticity. The most effective treatment forwidespread spasticity will be GABA replacement in the spinal fluid through a baclofen pump. Because most oral medications will have side effects, such as sedation and cognitive changes, introducing GABA in the spinal fluid will minimize those side effects. GABA replacement in the form of baclofen only requires a miniscule dosage, as opposed to oral meds. The average oral dose of oral baclofen is 20 to 80 milligrams per day, while a more effective response will only require 100 to 200 micrograms per daywhen injected intothespinalfluid.Thisrepresentsareduction of the dosage by the thousands, but with a better response. There is a test procedure used to determine if a baclofen pump will be helpful. After a spinal tap and injecting a small test dose of baclofen, your spasticity is monitored for at least four hours. If the test demonstrates a decreaseinspasmandpain,youareconsidered a candidate for a baclofen pump. Pump insertion is done on a different day, and it is usually done on an outpatient basis. Theprocedureinvolvesaneurosurgeonplacing the small pump in a pouch in the lower abdomen with a catheter anchored in the spine. The pump is a small computer and a reservoir for baclofen, and will release a programmed dosage on a 24 hours basis. The physician can adjust the dosage via computer. The pump reservoir will be refilled every few months and the battery will be good for about five years. After the pump is placed, it is often recommended to start physical therapy and monitor for spasms. The overall goal of this dual treatment is reducing spasms and pain, and improving mobility and function. In Conclusion While it is likely that you will be among the 80 percent of people with MS that experience some degree of spasticity, treatment options are available that will reduce pain and increase function.