Adductor spasticity may interfere with perineal hygiene, transfers, and catheter care. A sudden increase of spasticity may result from an occult or overt urinary tract infection. Baclofen is a GABA agonist that lessens spasticity, particularly of spinal cord origin. The main adverse effects of baclofen are drowsiness and increased weakness. Patients may be permitted to titrate their baclofen dosage independently, titrating lessened spasticity against greater weakness.
Some persons require some residual spasticity to assist standing.
Ambulation rarely improves significantly with baclofen. Intrathecal baclofen is indicated for patients with severe spasticity who are intolerant of or unresponsive to oral baclofen. It is most useful for patients with disabling spasms who are bed-bound or who cannot maintain perineal hygiene or cathether care because of spasticity. Alternatives to baclofen are few. Clonazepam, 0.25 mg daily up to 4 mg daily, may benefit spasticity through GABAergic mechanisms.