Spasticity: from pathophysiology to therapy

To be a fully effective, a treatment against spasticity has to match as closely as possible the major pathophysiological disorders responsible for increased tone and hyperreflexia. It is possible to analyze those existing at the spinal cord level by techniques of clinical neurophysiology. Among the functional modifications, increased excitability of alpha motoneurones, reduction in presynaptic inhibition and changes in interneuronal excitability are the most clearly documented. In fact, spasticity results from a combination in various proportions of these different pathophysiological troubles. As the myorelaxants have a specific mode of action, drug selected should be me which is the more able to correct the predominant trouble; this latter can easily be known by clinical neurophysiologic analysis.