The management of spasticity in adults

Major review of the research


Jonathan Marsden, a UK Professor, oversaw this review. He is a global authority on spasticity and its management, and has studied HSP for many years.

Jonathan Marsden
Jonathan Marsden


Here are some of the review’s highlights:

  • spasticity is difficult to manage and requires a collaborative approach involving multiple disciplines – doctors, physiotherapists, occupational therapists, orthotists, nurses and wheelchair engineers
  • the evidence for both drug and non-drug treatments of spasticity is limited
  • determining the effectiveness of various treatments of spasticity requires more research
  • referral to a rehabilitation specialist should be considered if oral anti-spasticity drugs don’t work well or aren’t tolerated; if the spasticity affects posture mobility and care; or if the spasticity is associated with considerable pain and discomfort
  • there is currently little evidence for the effectiveness of several physical modalities including extracorporeal shock wave therapy, whole-body vibration, transcutaneous electrical stimulation, repetitive transcranial magnetic stimulation, transcranial direct current stimulation and electromagnetic therapy
  • reduction of spasticity often unmasks underlying weakness. All anti-spasticity drugs cause muscle weakness. There is a trade-off between spasticity and weakness, as spasticity can provide some measure of postural stability and function
  • there is currently limited evidence for the efficacy of oral anti-spasticity drugs
  • oral anti-spasticity drugs should be started at a small dose and increased in small increments. Their effectiveness for an individual should be periodically reviewed and tapered off and stopped if not effective
  • the timing of taking oral anti-spasticity drugs and the dose should be tailored to the individual and to their lifestyle e.g. if walking, lower doses during daytime; the dose before bedtime and straight after waking up to reduce high tone
  • oral cannabis extracts do not change objective measures of spasticity
  • intrathecal baclofen, where a small precise dose is accurately delivered, results in a significant reduction in spasticity for carefully selected and screened patients who do not respond to other forms of treatment
  • phenol injections can be effective in treating spasticity in large powerful muscle groups close to the trunk such as the abductors of the thighs.


SOURCE: BMJ. 2014 Aug 5;349:g4737. doi: 10.1136/bmj.g4737.


The management of spasticity in adults.


Nair KP1, Marsden J2

1Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK [email protected].

2School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK.


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