New Consensus on Botulinum Toxin A Strategy for Post-Stroke Spasticity

Key Clinical Quote

“The use of Botulinum Toxin A (BoNT-A) and innovative techniques has facilitated a more individualized approach to treatment of post-stroke spasticity, which provides physicians with the opportunity to optimize outcomes and address multiple goals.”

— Gerard E. Francisco, MD, Physical Medicine and Rehabilitation, University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, TX, and co-authors

A comprehensive guide on optimizing the benefits of botulinum toxin A (BoNT-A) for patients suffering from post-stroke spasticity has been developed by an international group of neurological rehabilitation specialists with a collective experience of over 250 years in the field. The collaborative paper, aptly titled "A Practical Guide to Optimizing the Benefits of Post-Stroke Spasticity Interventions With Botulinum Toxin A: An International Group Consensus," aims to address technical challenges faced by neurological physicians and therapists.

The guide was organized around 3 key takeaways to provide clear guidance for health care professionals aiming to maximize the benefits of BoNT-A based interventions in their patients.

• Individualized approach to the treatment of spasticity in stroke: A patient-centered collaborative approach to treatment is recommended, and clinicians should adopt a flexible mindset when deciding when to re-inject with botulinum toxin. The guide walks clinicians through model treatment plans that may start with modest goals, with room to adjust over time to reach desired outcomes.
• Toxin Preparation and Injection Technique: The guide explores different methods and techniques commonly employed to perform BoNT-A injections. Clinicians are urged to familiarize themselves with the variability in practice for preparing and handling the toxin, and in techniques used for localization, analgesia, dilution, and muscle targeting.
• Concomitant and adjunctive therapies: With BoNT-A injections being just one part of spasticity management, the specialists agreed that the treatment should always be followed with a physiotherapy program. The guide lays out techniques that the authors currently use, as well as how to establish the optimal adjunctive therapy to be used alongside BoNT-A.

“The use of BoNT-A and innovative techniques has facilitated a more individualized approach to treatment of post-stroke spasticity, which provides physicians with the opportunity to optimize outcomes and address multiple goals,” researchers conclude in the guide. The table included in the paper “outlines the consensus view of best practice on the optimal use of BoNT-A within a multidisciplinary context, including use of adjunctive therapies that are commonly employed with BoNT A. BoNT-A usage and choice of adjunctive procedures should be made according to individual needs and treatment goals.”

Reference

Francisco GE, Balbert A, Bavikatte G, et al. A practical guide to optimizing the benefits of post-stroke spasticity interventions with botulinum toxin A: An international group consensus. J Rehabil Med. 2021;53(1):jrm00134. Published 2021 Jan 1. doi:10.2340/16501977-2753