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Treatment options for spasticity in adults

Diagnosis and treatment of PSS during the first 3 months post-stroke may benefit patients in their aim for a full recovery5,6

Combining physical therapy and BOTOX® may help patients reach their goals.7-9

Adapted from Royal College of Physicians, 201810 and Bhakta BB, 200011

BOTOX® should only be used for the treatment of focal spasticity in adult post-stroke patients if muscle tone reduction is expected to result in improved function (e.g. improvements in gait), or improved symptoms (e.g. reduction in muscle spasms or pain), and/or to facilitate care.12

Management strategy for adults with spasticity10

Adapted from Royal College of Physicians 201810

PSS: post-stroke spasticity.

BOTOX® (botulinum toxin type A) is indicated for the treatment of focal spasticity including:12

  • 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. Stinear C, Ackerley S et al. Rehabilitation is initiated early after stroke, but most motor rehabilitation trials are not: a systematic review. Stroke 2013 Jul;44(7):2039-45
  6. Rosales RL, Efendy F et al. Botulinum toxin as early intervention for spasticity after stroke or non-progressive brain lesion: A meta-analysis. J Neurol Sci. 2016;371:6-14
  7. Uchiyama Y, Koyama T et al. Botulinum Toxin Type A Treatment Combined with Intensive Rehabilitation for Gait Poststroke: A Preliminary Study. J Stroke Cerebrovasc Dis. 2018;27(7):1975-1986
  8. McCrory P, Turner-Stokes L et al. Botulinum toxin A for treatment of upper limb spasticity following stroke: A multi-centre randomized placebo-controlled study of the effects on quality of life and other person-centred outcomes. J Rehab Med 2009 41(7):536-44
  9. Ward AB, Wissel J et al. Functional goal achievement in post-stroke spasticity patients: the BOTOX® Economic Spasticity Trial (BEST). Journal of Rehabilitation Medicine. 2014;46(6):504-513
  10. Royal College of Physicians. Spasticity in adults: management using botulinum toxin. National guidelines, March 2018. Available at: Accessed October 2022
  11. Bhakta BB. Management of spasticity in stroke. Br Med Bull. 2000;56(2):476-85
  12. 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-220204.