[Pharmacology and upper limb poststroke spasticity: a review. International Society of Prosthetics and Orthotics].
OBJECTIVE
The present study, conducted for the consensus conference "Orthotic management of stroke patients", organized by the International Society of Prosthetics and Orthotics, on September 2003, reviews the pharmacological, general, or local treatments available for post-stroke upper-limb spasticity.


METHODS
A search of the international literature in the Medline and the Reedoc data banks for papers related to post-stroke upper-limb spasticity. Each paper was given a rating of A, B, or C (in term of quality) according to the instructions of the organization committee.


RESULTS
General pharmacological treatments such as use of baclofen, tizanidine and dantrolene, regional treatments such as intrathecal baclofen, and local treatments with use of chemical neurolysis and alcohol or phenol are recommended for conditions described in papers with a grade of B. Neuromuscular blockade with botulinum toxin is recommended for conditions described in papers with a grade of A.


CONCLUSIONS
Despite a satisfactory grade of recommendation, general pharmacological treatments are limited by adverse events and lack of evidence of functional benefit. Intrathecal baclofen should be discussed for upper-limb spasticity, but further studies are needed before its use can be recommended. The place of chemical neurolysis with use of alcohol or phenol should be evaluated with surgical neurotomy and botulinum toxin therapy. The use of botulinum toxin is the only treatment supported by scientific results, but many questions remain about the site of injection, how to improve efficacy and influence on neurological recovery.
Service de médecine physique et de réadaptation, GH Lariboisière, F.-Widal, AP-HP, 200, rue du Faubourg-Saint-Denis, 75475 Paris, cedex 10, France. alain.yelnik@lrb.ap-hop-paris.fr <alain.yelnik@lrb.ap-hop-paris.fr>
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Yelnik
D001132:Arm / Q000503:physiopathology; D001418:Baclofen / Q000008:administration & dosage / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use; D003000:Clonidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003620:Dantrolene / Q000627:therapeutic use; D006804:Ergonomics; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007273:Injections, Intramuscular; D007278:Injections, Spinal; D009121:Muscle Denervation; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*; D019148:Neuromuscular Blockade; D019800:Phenol / Q000008:administration & dosage / Q000627:therapeutic use; D026741:Physical Therapy Modalities; D020521:Stroke / Q000150:complications*
D009465:Neuromuscular Agents; D019800:Phenol; D000431:Ethanol; C023754:tizanidine; D019274:Botulinum Toxins, Type A; D003620:Dantrolene; D001418:Baclofen; D003000:Clonidine