J Neurol Neurosurg Psychiatry 80:359 doi:10.1136/jnnp.2008.164889
  • Editorial commentary

Botulinum toxin should be first-line treatment for poststroke spasticity

  1. Geoffrey Sheean
  1. Dr Geoffrey Sheean, Department of Neurosciences, UCSD, 402 Dickinson Street, Suite 190, San Diego, CA 92103-8465, USA; gsheean{at}
  • Received 17 November 2008
  • Accepted 25 November 2008

Each year, about 100 000 people in the UK suffer their first stroke,1 of which some will die, and many of the survivors will suffer significant impairment.2 Much of the impairment is due to neurological deficits from damage to motor, sensory and language pathways. Some survivors also develop some type of motor overactivity as a result of damage to the upper motor neurons: spasticity is one type and affects up to 38% of patients after stroke.3 Spasticity can result in postural deformity, pain and impaired passive and active movement, and consequently impaired function. Quality of life is reduced,4 and care giver burden is increased.5

Before the advent of botulinum neurotoxin (BoNT) therapy, treatment of spasticity after stroke consisted of physiotherapy measures (stretching, splinting, casting) and oral anti-spasticity agents, such as baclofen, …

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