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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



  1. Allergan. Data on file. INT/0423/2016
  2. 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
  3. 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
  4. Allergan. Data on file. 014
  5. Royal College of Physicians. Spasticity in adults: management using botulinum toxin. National guidelines 2018. Available at: management-using-botulinum-toxin. Accessed January 2023
  6. 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
  7. BOTOX® Summary of Product Characteristics. Available at: 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.