The treatment of spasticity should strictly follow functional considerations in modern
neurological rehabilitation. The therapeutic team will develop a multi-lever treatment
program for spasticity, with drugs being only one of several options. Oral antispastic
medication seems to have lost influence over the last years, at least in stroke rehabilitation.
Painful muscle twitches related to spasticity and functionally incapacitating cloni
may be an indication, and a close monitoring of the patients at the beginning of the
treatment is helpful to detect fatigue and muscle weakness as well known side effects.
A new promisising option is gabapentin. Botulinum toxin A and B are first choice in
the treatment of focal spasticity. The „Rote Liste“ names adult upper limb flexor
spasticity and CP-related equinovarus deformity as labelled indications. For stroke
patients with upper limb flexor spasticity, several controlled trials showed a muscle
tone reduction, ease of personal hygiene and pain reduction in the verum group following
the injection of BTX-A. Motor control did not differ between the verum and placebo
groups. BTX-B and a highly purified toxin are currently under investigation. A new,
old and rather cheap alternative is the neurolytic treatment of focal spasticity with
phenol 5%. The EMG-guided local injection of the N. musculocutanaeus or N. tibialis
resulted in an immediate muscle tone reduction, effects could last up to 8 months,
potential side effects in up to 10% of subjects were a regional dysaesthesia. The
intrathecal application of baclofen, long established in the treatment of severe spinal
spasticity, has now also been tested in the spasticity management of CP children,
and stroke patients. Controlled trials are warranted.
