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What is post-stroke spasticity (PSS)?

What is spasticity?

  • Spasticity is a common consequence of neurological disorders, such as stroke,5 and presents as intermittent or sustained involuntary activation of muscles6
  • Spasticity primarily affects the elbow, wrist and ankle7
  • If left untreated, spasticity can cause shortening of muscles and tendons, and a vicious cycle can develop8

Adapted from Royal College of Physicians. Spasticity in adults: management using botulinum toxin, 20188

Features of spasticity8

Prevalence of PSS increases with post-stroke survival time9


Adapted from Wissel J et al, 20139

Data on the time course of post-stroke spasticity was compiled, via a literature search, from nine studies using the Modified Ashworth Scale and the Tone Assessment Scale for monitoring increased muscle tone.9

A timely diagnosis may avoid worsening of untreated spasticity10


Neural changes may drive the onset of post-stroke spasticity11,12

  • If patients are not treated in a timely manner, their spasticity is likely to become more disabling over time, causing pain, deformity and contracture10
  • Intrinsic muscle changes between 3 and 18 months may lead to chronic severe spasticity, preventing a full recovery9,11,12
  • Rehabilitation therapies applied within the first 3 months after stroke are likely to deliver benefit16

PSS: post-stroke spasticity.

BOTOX® (botulinum toxin type A) is indicated for the treatment of focal spasticity including:17

  • 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. Kheder A, Nair K P. Spasticity: pathophysiology, evaluation and management. Pract Neurol 2012;12(5):289-298
  6. Pandyan A D, Gregoric M et al. Spasticity: clinical perceptions, neurological realities and meaningful measurement. Disabil Rehabil 2005;27(1-2):2-6
  7. Thibaut A, Chatelle C et al. Spasticity after stroke: physiology, assessment and treatment. Brain Inj 2013;27(10):1093-1105
  8. Royal College of Physicians. Spasticity in adults: management using botulinum toxin. National guidelines, March 2018. Available at: Accessed September 2022
  9. Wissel J, Manack A, Brainin M. Toward an epidemiology of poststroke spasticity. Neurology 2013;80(3 Suppl 2):S13-19
  10. Glaess-Leistner S, Ri S J et al. Early clinical predictors of post-stroke spasticity. Top Stroke Rehabil 2020:1-11
  11. Thilmann A F, Fellows S J, Garms E. The mechanism of spastic muscle hypertonus. Variation in reflex gain over the time course of spasticity. Brain 1991;114 ( Pt 1A):233-244
  12. Welmer A K, Widen Holmqvist L, Sommerfeld D K. Location and severity of spasticity in the first 1-2 weeks and at 3 and 18 months after stroke. Eur J Neurol 2010;17(5):720-725
  13. Opheim A, Danielsson A et al. Early prediction of long-term upper limb spasticity after stroke: part of the SALGOT study. Neurology 2015;85(10):873-880
  14. Fellows S J, Ross H F, Thilmann A F. The limitations of the tendon jerk as a marker of pathological stretch reflex activity in human spasticity. J Neurol Neurosurg Psychiatry 1993;56(5):531-537
  15. Sommerfeld D K, Eek E U et al. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke 2004;35(1):134-139
  16. Stinear C, Ackerley S, Byblow W. Rehabilitation is initiated early after stroke, but most motor rehabilitation trials are not: a systematic review. Stroke 2013;44(7):2039-2045
  17. BOTOX® Summary of Product Characteristics. Available at: Accessed October 2022

Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.


Adverse events should be reported. Reporting forms and information can be found at or via the MHRA Yellow Card app, available in the Google Play or Apple App Stores.

Adverse events should also be reported to AbbVie on [email protected] 


Date of preparation: October 2022. UK-BTX-220201.