Medical treatment of spasticity

Spasticity is one of the clinical signs observed after a lesion of the pyramidal tract. Clinical manifestations (ire polymorphous and depend on the location of the lesion on the pre-motoneuron. Functional consequences (ire also variable. Only negative effects such as painful spasms, stiffness. distortions, are to be treated. Three different categories of drugs (ire available: GABA-like (baclofen, benzodiazepine), central alpha 2 agonists (tizanidine, clonidine) and peripheral anti-spastics (dantrolene). Baclofen remains the most commonly used anti-spastic. The preferential indication is spasticity,from spinal cord disease. especially when the aetiology is multiple sclerosis. Efficacy of benzodiazepines (diazepam, tetrazepam, clonazepam) is comparable with baclofen; however, side effects (drowsiness) are more frequent. Benzodiazepines are indicated when spasticity is associated with anxiety. Tizanidine is an efficient and well tolerated anti-spastic. In France,, prescription requires a temporary authorization of use. Dantrolen has a peripheral mechanism of action and can be prescribed in the different forms of spasticity. There are other compounds with anti-spastic properties (gabapentine, cyproheptadine, piracetam). Their advantage is rather limited when used alone. Generally they are administrated in combinaison with usual anti-spastic drugs.