Spasticity is a common symptom observed after pyramidal system lesion. The treatment of spasticity has considerably changed during last years, notably with the generalization of Botulinum toxin use. However, the treatment of spasticity should consider all therapeutic possibility in accordance with patient status and objective. Drugs are only a part of the treatment and physical therapy must always be used. Others treatments such as surgery, orthosis, occupational therapy must also be discussed individually. Several guidelines are now available for Botulinum toxin treatment but only the French guidelines consider all drug therapies. This review addresses the different drugs commonly used on the basis of an extensive review of literature. Some facts are clearly established by randomized controlled trials but a certain number of questions remains unclear and only clinical experience and consensus can guide injectors.