Neurochirurgie 2003 May;49(2-3 Pt 2):247-55
Rode G, Maupas E, Luaute J, Courtois-Jacquin S, Boisson D.
Service de Reeducation Neurologique, Hopital Henry-Gabrielle, Hospices Civils de Lyon et Universite Cl.-Bernard Lyon-I.
Spasticity is one of the clinical signs observed after a lesion of the pyramidal tract.
Clinical manifestations are polymorphous and depend on the location of the lesion on the pre-motoneuron.
Functional consequences are also variable.
Only negative effects such as painful spasms, stiffness, distortions, are to be treated.
Three different categories of drugs are 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 antispastic.
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.