Role of oral medications in spasticity management

Oral medications are frequently used to manage spasticity. Some clinicians may believe that oral medications are a more conservative or "first-line" strategy to treat this condition. However, their use may lead to significant adverse events. Additionally, efficacy has not been well-established, in particular the ability of these medications to enhance functional outcome. The decision regarding the use of oral medications is further complicated by the fact that a number of different agents have been used for many different diagnoses. The relative dearth of well-controlled studies makes the choice of medications for a given clinical condition even more difficult. This article reviews the mechanisms of action of some of the medications that are more commonly used to treat spasticity and identifies some studies that may suggest efficacy, or lack thereof, for certain diagnoses. Because questions remain regarding the benefit of oral medications, potential side effects also are emphasized to help the reader consider both potential risks and benefits. The article is intended as a broad overview, rather than comprehensive review of the literature.