Pharmacologic management of spasticity of spinal origin is determined in part by several factors: 1) evidence of a spasticity-related dysfunctional profile, 2) acknowledgement of the clinical effectiveness and side effects of commonly utilized pharmacologic agents, 3) pathophysiologic mechanisms and spinal plasticity (neuronal excitability, anatomical and biochemical reorganization), 4) pharmacokinetics and subject compliance, and 5) unique methods of drug administration. Presently, preferred agents include systemically administered substances, which presumably act at the level of segmental and intersegmental interneuronal circuitry-e.g. baclofen or clonidine, and at the level of muscle contractile tissue-e.g. dantrolene sodium. This paper also describes the action of intrathecally administered morphine on spinal spasticity in subjects resistant to the action of oral agents.
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