Botulinum toxin in Post Stroke Spasticity By Dr. Sorabh gupta

Описание: ⸻

🔹 Role of Botulinum Toxin in Post-stroke Spasticity

Botulinum toxin (especially BoNT-A) is the treatment of choice for focal spasticity after stroke.

⸻

🔹 Mechanism of Action
• BoNT blocks acetylcholine release at the neuromuscular junction.
• Causes temporary chemodenervation → muscle relaxation.
• Effect lasts about 3–4 months, after which re-innervation occurs.

⸻

🔹 Indications
• Focal or multifocal spasticity interfering with:
• Limb positioning
• Mobility and walking
• ADLs (e.g., dressing, hygiene, feeding)
• Pain or discomfort
• Common targets:
• Upper limb: flexor muscles (biceps, wrist/finger flexors, pronator teres).
• Lower limb: adductors, gastrocnemius/soleus (equinovarus foot).

⸻

🔹 Administration
• Given by injection into affected muscles.
• Guidance methods:
• Clinical/anatomical landmarks
• EMG, electrical stimulation, or ultrasound (preferred for accuracy).

⸻

🔹 Dosing (approximate, varies with formulation & guidelines)
• OnabotulinumtoxinA (Botox®):
• Total dose: up to 400 U per session (some guidelines allow higher).
• AbobotulinumtoxinA (Dysport®):
• Total dose: up to 1500 U.
• Dose is divided among multiple muscles depending on spastic pattern.

⸻

🔹 Onset & Duration
• Onset: 3–7 days.
• Peak: 2–6 weeks.
• Duration: 3–4 months → repeat injections needed.

⸻

🔹 Side Effects
• Local: pain at injection site, localized weakness.
• Systemic (rare): flu-like symptoms, generalized weakness, dysphagia (esp. with neck injections).

⸻

🔹 Advantages
• Localized effect (spares non-target muscles).
• Reduces spasticity, pain, and contracture risk.
• Improves function, hygiene, and caregiver ease.
• Can be combined with physiotherapy, splints, oral meds.

⸻

✅ Key Point: Botulinum toxin A is first-line for focal post-stroke spasticity, especially when it causes pain or interferes with function, and works best as part of a multidisciplinary rehabilitation program.