[Medical treatment of spasticity].
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.
Service de Rééducation Neurologique, Hôpital Henry-Gabrielle, Hospices Civils de Lyon et Université Cl.-Bernard Lyon-I.
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G
Rode
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Maupas
J
J
Luaute
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S
Courtois-Jacquin
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D
Boisson
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D018755:GABA Agonists / Q000627:therapeutic use*; D006801:Humans; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000150:complications / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D013116:Spinal Cord / Q000503:physiopathology
D000316:Adrenergic alpha-Agonists; D018755:GABA Agonists; D009125:Muscle Relaxants, Central; D009465:Neuromuscular Agents