Botulinum toxin A treatment of adult upper and lower limb spasticity

This article discusses the treatment of spasticity with botulinum toxin A a s a new approach in the neurological rehabilitation of patients after strok e. Clinical studies have been reviewed to provide information about target groups, technical aspects and the advantages and disadvantages of treating spasticity with botulinum toxin A. Open and controlled studies showed that the intramuscular injection of Dyspert (R) 500 to 1500U or Botox (R) 100 to 300U could reversibly relieve upper limb flexor and lower limb extensor sp asticity. A reduced muscle tone, pain relief, better hand hygiene and impro ved walking function were the main benefits. Patients tolerated the treatme nt well. Activity or, if not possible, electrical stimulation of the inject ed muscles may enhance the effectiveness of the costly toxin. Serial castin g is another option. With respect to the action of botulinum toxin A, it is suggested that the effect of the toxin could be mediated by paresis of bot h the extrafusal and intrafusal muscle fibres, thereby altering the afferen t discharge in the muscle.