Muscle spasticity
Increased muscle tone from upper motor neuron lesions (MS, stroke, spinal cord injury) or local muscle spasms. Treated with muscle relaxants, physiotherapy, and botulinum toxin when indicated.
ICD-10 R25.22 drugs
Also known as: Muscle spasm
Drugs used for this condition
- BDiazepamAdd-on therapy · Anxiolytics. Benzodiazepine derivativesDiazepam is used as a muscle relaxant for central spasticity (MS, spinal cord injury) and painful muscle spasms. Efficacy demonstrated in small RCTs. Modern practice prefers baclofen and tizanidine due to less sedation and lower dependence risk.
- BTolperisoneSecond line · Centrally acting muscle relaxantPost-stroke spasticity in adults is the only indication the EMA left tolperisone after its 2012 Article 31 review. The evidence base is modest: in the one study of acceptable quality the Ashworth score improved by 32% against 14% on placebo, with the effect stronger at 300–450 mg daily. The adult dose in the SmPC is 150–450 mg a day in three doses, taken after food because absorption falls on an empty stomach. Safety and efficacy in children are not established. In moderate renal or hepatic impairment the dose is titrated individually; in severe impairment the drug is not used. Work on post-stroke spasticity does not come down to a tablet: rehabilitation and positioning carry it, and focal spasticity is treated with botulinum toxin.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit