It is important to consider many steps in the treatment of patients with problematic spasticity: establish the functional impact of the spasticity; identify the functional goal to be achieved by treatment; eliminate any remediable spasticity aggravating factors; evaluate the effects of previous antispasticity treatments; consider nonpharmacologic and pharmacologic treatments; initiate therapy with a low dosage; titrate judiciously; stop the titration when function goal is achieved; and if goal is not achieved or if side effects are intolerable, consider a second medication.