What are BoNT-A injection strategies for 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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BoNT-A is injected using a 23- to 27-gauge needle. Larger and superficial muscles are identified by palpation, while small or deep muscle groups are identified by electromyography (EMG) or electrical stimulation (ES). Ultrasonography, fluoroscopy, or computed tomography (CT) scanning also may be used. Local anesthetic cream, general anesthesia, or sedation may be necessary, particularly for some children.

Depending on the location and severity of spasticity, BoNT-A injections usually are needed at 3- to 6-month intervals to maintain therapeutic benefit. Reinjections should not be given any sooner than 3 months after the last injections to decrease the possibility of antibody formation.

A study by Molenaers et al of 577 patients with cerebral palsy, all of whom were younger than 24 years at the time of treatment, found that Goal Attainment Scale scores were higher for patients who received multilevel injections of BoNT-A or injections of the drug only in the distal muscle groups than they were for patients who received the injections only in the proximal muscles of the lower limb. [39]

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