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- Discussion:
    - spasticity is defined as "a velocity-dependent increase in tonic stretch reflexes;"
    - muscle contractions, which can be violent, may also occur, initiated by even slight stimulation;
    - severity of spasticity is difficult to measure and can vary from moment to moment;

- Medications:
    - diazepam
          - works at the brain stem level and spinal level;
          - limiting factor is the degree of sedation;
    - dantrolene
          - acts directly on muscle
          - 25 mg PO qid, w/ incr 25-50 mg q 3-4 hrs (not to exceed 800 mg)
          - side effects include lethargy and headache;
    - baclofen (20 mg/day in D.D.), diazepam, & clonidine (0.2-0.4 mg/day)
          - works at the level of the spinal cord, and is more effective in lesions of the spinal cord and is less effective is cases of spasticity 
                 resulting from central lesions;
          - 80% excreted into the urine;
          - start w/ 15 gm qd,  w/ 5 gm increases q 3-4 days, not to exceed 80 gm per day

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Original Article: Intrathecal Baclofen For Severe Spinal Spasticity.

Management of spasticity in spinal cord injury. 

Management of Spasticity with Neuromuscular Blockade: The Role of Botulinum Toxin from the Orthopaedic Care Textbook