A Cochrane review [Abstract] 1 included 26 placebo-controlled studies, using baclofen, dantrolene, tizanidine, botulinum toxin, vigabatrin, prazepam, threonine and cannabinoids, and 13 comparative studies. Only 15 of the studies used the Asworth scale, of which only three of the eight placebo-controlled studies and none of the seven comparative studies showed a statistically significant difference between test drugs. Spasms, other symptoms and overall impressions were only assessed using unvalidated scores and results of functional assessments were inconclusive.
Comment: The quality of evidence is downgraded by the study quality (inadequate allocation concealment), inconsistency (heterogeneity in interventions, measurements and outcomes) in indirectness (the evaluation tool most commonly used here is questionable as regards the measurement of spasticity).
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