In 2008 one of our most downloaded papers was Mike Barnes' review article on the management of spasticity published ten years earlier (Age Ageing 1998; 27: 239-245). The Editorial Board therefore commented that there was a need for an updated review on this topic, to include the latest information on the epidemiology, pathogenesis, clinical presentation and management of spasticity. I am therefore delighted that this issue includes an updated review of spasticity written by Laura Graham, one of Mike Barnes' successors in Newcastle (435-41). This emphasises that spasticity is common after stroke and other neurological conditions, where it restricts function and impairs quality of life. The modification of factors which may aggravate spasticity and the use of physical therapies addressing muscle tone, posture and positioning are essential in the management of the condition, as existing pharmacological interventions have only limited effect. Nevertheless, there does appear to be some benefit from the targeted use of botulinum toxin injections. The article underlines the importance of a multidisciplinary holistic approach to the management of patients with spasticity. It also highlights that the relative lack of good outcome measures and the heterogeneity of clinical presentation have hindered the development of randomised controlled trials of therapeutic interventions. Hopefully this article will not only provide useful advice on the management of spasticity, but also encourage further research into this distressing problem.
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