I’m not an MS specialist, but the pharmacology questions that come up around spasticity management have a lot in common with other fields, so I’ve followed the literature a bit. A lot of threads seem to frame the choice between meds as just trying things until something works, but the decision between something like oral baclofen and targeted Botox injections is really a choice between two completely different mechanical approaches.
Baclofen is systemic, it’s a GABA-B agonist that acts mostly at the spinal cord level to basically turn down the gain on hyperactive reflexes. It’s a central approach to a central problem.
The major limitation is that it’s a shotgun, not a rifle. The dose that calms the spasticity