Experience of botulinum toxin in the management of spasticity

Hunters Moor Regional Rehabilitation Centre has used botulinum toxin A to treat spasticity for the past 5 years, treating mainly adults with brain damage acquired from head injury or stroke and using the toxin as part of a multidisciplinary approach to their treatment. In this population botulinum toxin A has demonstrated definite antispastic effects and an additional analgesic effect. The toxin is simple and quick to administer and is a useful addition to other therapies, for example by facilitating physiotherapy treatment, orthosis-fitting and improvement of the patient's sitting position. It has few side effects, and can produce apposite short-term effects, which is important in recoverable conditions such as stroke and head injury. Disadvantages include the short-lived nature of the agent's pharmacological effects and expense. Nevertheless, early intervention with botulinum toxin A may avoid many long-term problems. Further research is needed to support this approach. In particular, carefully controlled studies are needed to clarify the dose-response relationship for individual muscles.