Abstract
Severe spasticity and painfull muscle spasms worsen quality of life, mobility and self-care in patients suffered form chronic spinal cord injury. Poorly managed spasticity leads to serious long-term complications such as pressure sores, chronic pain, infections and fixed muscle contractures.
Ashworth scale of muscle hypertonia, frequency of muscle spasms and visual analogue scales are the most common ones used in clinical practice for evaluation of spasticity. The most common treatment of spasticity is oral drug therapy (benzodiazepines, tizanidine, and baclofen).
A local administration of botulinum toxin is suitable for focal spasticity in a small muscle group. In severe flexed spasticity, ablation procedures may be performed, such as selective peripheral neurotomy, lateral longitudinal myelotomy and posterior rhizotomy.
Physical treatment is also very important. In severe generalized spasticity a long-term treatment often needs higher oral doses of drugs or various drug combinations, which leads to exaggeration of general adverse effects.
Intrathecal continuous baclofen administration could resolve this problem. Management of spasticity is a long-term process and it needs multidisciplinary approach to achieve the real treatment goal for each patient.