What is the role of botulinum toxin in the treatment of spasticity?

Updated: Jun 28, 2019
  • Author: Krupa Pandey, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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A guideline from the American Academy of Neurology recommends offering botulinum toxin as a treatment option to reduce muscle tone and improve passive function in adults with spasticity (level A recommendation). It also recommends considering botulinum toxin injection to improve active function (level B). [24] (Collateral sprouting of the axon occurs in about 3 months, eliminating any permanent neurologic effect.)

Patients with focal spasms are candidates for focal treatment with botulinum toxin A (BoNT-A). Patients with segmental or nongeneralized spasticity may be candidates for systemic or intrathecal baclofen treatment, with BoNT-A added for focal symptom relief.

In 2009, the US Food and Drug Administration (FDA) required a boxed warning for all botulinum toxin products—types A and B—because of reports that the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing effects similar to those of botulism. These effects have included life-threatening, and sometimes fatal, swallowing and breathing difficulties. Most of the reports involved children with cerebral palsy being treated for spasticity. [25, 26, 27]

After botulinum injection, therapeutic interventions have multiple aims, including strengthening and facilitation, increasing range of motion, retraining of ambulation and gait, improving the fit and tolerance of orthoses, and improving functioning in activities of daily living (ADLs). Decreased spasticity and improvements in range of motion and strength have considerable implications for activities such as dressing, bathing, feeding, and grooming.

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