Table 12.

Management options for spasticity in patients with transverse myelitis

Management Strategy	Comment
Nonpharmacologic measures	Physical therapy, stretching exercises, orthotics, and aquatic therapy Useful for mild cases.
Pharmacologic therapy	Baclofen Tizanadine Dantrolene (must monitor liver function tests) Anticonvulsants Benzodiazepines Anticonvulsants and benzodiazepines are useful for paroxysmal tonic spasms. Sedation may limit the use of the above-mentioned drugs.
Botolinum neurotoxin	Particularly useful for nonambulatory patients with severe adductor spasms that complicate adequate perineal hygiene.
Intrathecal baclofen (ITB)	May be used when oral medications cause too much sedation. Patients must be carefully evaluated before ITB use because of serious risks associated with baclofen withdrawal.