Management of spasticity

Recent open studies and two placebo-controlled studies confirm the potential role of Botulinum toxin A in the treatment of focal spasticity in adults and children. The effect of the toxin might not only be mediated by the paresis of extrafusal, but also intrafusal muscle fibres, thereby altering the afferent discharge. To enhance its effectiveness, an additional electrical stimulation seems promising. Most patients tolerate the neurolytic agent well. Two individuals, however, suffered from an intermittent tetraparesis after treatment. The repetitive magnetic stimulation and the use of gabapentin might be other new therapeutic options in the management of spasticity.