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      • This website is for UK Healthcare Professionals only

      UK-BNO-230019. DOP: January 2023.

      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

      TIME POST-STROKE:

      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

      POST-STROKE TIMELINE

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

      und 4
      • 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

       

      References

      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: www.rcplondon.ac.uk. 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: www.medicines.org.uk. 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.

      BOTOX® PRESCRIBING INFORMATION

       

      Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/ 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.

       

       

      Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk 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]

       

      This website is for UK Healthcare Professionals only

      UK-ABBV-230225. Date of preparation June 2023. This website has been developed and funded by AbbVie Ltd.

      © 2023 AbbVie Ltd. All rights reserved. Registered Number: 08004972 England.