UK-BNO-230019. DOP: January 2023.
Guidelines recommend BOTOX® as a treatment option in the management of post-stroke spasticity (PSS)5
Botulinum toxin type A is a recommended option in the Royal College Of Physicians National Guidelines (2015) - Spasticity in adults: management using botulinum toxin5
Royal College Of Physicians – Spasticity In Adults: Management Using Botulinum Toxin (National Guidelines 2018)5
Early intervention: When combined with rehabilitation, botulinum toxin has been shown to provide a sustained reduction in post-stroke upper-limb spasticity as early as 2–12 weeks post-stroke6
Multidisciplinary approach: Botulinum toxin should be used as part of a coordinated multidisciplinary approach, involving physical management and therapy
Role for physiotherapists and nurses: In accordance with UK statutes, appropriately experienced and qualified physiotherapists and nurses may be trained to prescribe and inject botulinum toxin; this may be highly cost-efficient
Secondary benefits: A successful treatment package can also prevent secondary complications such as impaired movement and difficulty maintaining hygiene and self-care
Core principles for intervention5
The principles for successful botulinum toxin intervention are:
- Appropriate patient selection (e.g. dynamic spastic component as opposed to contracture)
- Clear, realistic and worthwhile goals for treatment agreed with patients and families (e.g. pain relief; reduction of involuntary movements; mobility)
- Establishment of the immediate and ongoing treatment programme
Adapted from Royal College of Physicians 20185
GAS: goal attainment setting; PSS: post-stroke spasticity; SMART: Specific, Measurable, Achievable, Realistic and Timed.
BOTOX® (botulinum toxin type A) is indicated for the treatment of focal spasticity including:7
- wrist and hand disability due to upper limb spasticity associated with stroke in adults
- ankle and foot disability due to lower limb spasticity associated with stroke in adults
References
- Allergan. Data on file. INT/0423/2016
- Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache 2011;51(9):1358-1373
- Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain 2018;19(1):13
- Allergan. Data on file. 014
- Royal College of Physicians. Spasticity in adults: management using botulinum toxin. National guidelines 2018. Available at: https://www.rcplondon.ac.uk/guidelines-policy/spasticity-adults- management-using-botulinum-toxin. Accessed January 2023
- Rosales, Raymond L., et al. Botulinum toxin injection for hypertonicity of the upper extremity within 12 weeks after stroke: a randomized controlled trial. Neurorehabilitation and neural repair 2012;26: 812-821
- BOTOX® Summary of Product Characteristics. Available at: www.medicines.org.uk. Accessed January 2023
Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.
Date of preparation: January 2023. UK-BTX-220210.
