Treatments for spasticity (overactive muscle contractions) following brain injury

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Treatments for spasticity (overactive muscle contractions) following brain injury

Synnot A, Chau M, Pitt V, O’Connor D, Gruen RL, Wasiak J, Clavisi O, Pattuwage L, Phillips K

Review question

We reviewed the evidence about the effect of treatments (drug and non-drug) for spasticity following a brain injury caused by a blow to the head (traumatic brain injury (TBI)).


Many people with TBI experience muscle spasticity, when their muscles contract or tighten involuntarily. This can impact on a person’s ability to carry out daily activities causing pain, stiffness and broken skin. There are many treatments used to manage spasticity, including medicines, casting, splints and stretches. Often, these treatments are used in combination.

Study characteristics

We included nine studies in this review which involved 134 participants with TBI. Only five studies, including 105 people provided usable results. These studies tested the effects of a range of treatments, including medicines (baclofen or botulinum toxin A), casting, physiotherapy, splints, a table that moves people from the lying position to standing and electrical stimulation (where electrical impulses are delivered to the muscles). Studies inadequately reporting results had tested the effect of medicines (baclofen or tizanidine).

Study funding sources

Of the five studies with results, three were funded by governments, charities or health services and two were funded by a drug manufacturer and medical technology company. The other four studies without useable results were funded by drug manufacturer or medical technology companies.

Key results

This evidence is current to June 2017.

Interpreting the results of the studies was difficult because of a lack of information and concerns about the quality of the evidence. For spasticity, some studies concluded that the treatment they tested made an improvement, and others found no difference between treatments. The most common side effect was minor skin damage in people who received casting. We believe it would be misleading to provide any further description of study results given the quality of the evidence was very low for all measurements.

Quality of the evidence

The quality of this evidence was very low; we only had five studies with results and none of the studies were large or comparable with one another. We also had concerns about how they were conducted or analysed. Because of this, we cannot draw any firm conclusions about the benefits and harms of different treatments for spasticity in people with TBI.

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