Botulinum toxin type A treatment of upper limb spasticity

In recent years, local injections with Botulinum toxin type A (BtxA) have b ecome the treatment of choice for dystonia. However, several studies have d emonstrated its efficacy and safety in the treatment of focal spasticity as well. These studies have shown efficacy and safety in upper limb spasticit y treatment at a total dose between 500 and 1500 units of Dysport (R) per i njection session. While injections in upper arm muscles are easily administ ered without EMG-guidance, we recommend EMG-guidance for lower arm and fing er muscles. In addition to functional improvement, BtxA treatment may also be considered for the following reasons: treatment of spasticity associated pain or painful muscle spasms, improved hygiene, facilitation of care, pre vention of skin breakdown, and improved positioning of the upper limb. The definition of a realistic treatment goal, in agreement with the patient, as well as adjunctive physiotherapy are prerequisites for a successful BtxA t reatment. Dose recommendations are given in Table 1.