Action of cyproheptadine in spastic paraparetic patients

The antiserotonergic agent cyproheptadine was evaluated in six patients as a medication for the management of spasticity due either to spinal cord trauma or to multiple sclerosis. Oral doses of cyproheptadine were progressively increased from 6 mg to 24 mg per day. Trial periods extended from 4 to 24 months and included a placebo substitution period. Cyproheptadine was found to decrease significantly the spontaneous and elicited ankle clonus in all six patients and spontaneous spasms in five patients. Cyproheptadine decreased the EMG activity and the dynamic strength produced by the knee extensor and flexor muscles during isokinetic movements in two of the four patients evaluated objectively. Subjectively, however, the patients did not report diminished strength.