Botulinum toxin for treatment of spasticity in adults

Although a few hundred papers have been published on the treatment of adult spasticity with botulinum toxin, the number of randomized placebo-controlled double-blind studies, by comparison, is relatively small. Criteria of highest evidence classes are met by the following observations: 1) Botulinum toxin improves motor functions (ability to walk and stand in the presence of spastic equinus deformity and knee flexor spasticity, upper-extremity movements). 2) Botulinum toxin makes attendance of spastic adults easier (personal hygiene in patients presenting with severe adductor spasticity; self-care and dressing in the presence of arm spasticity). 3) Early initiation of treatment with botulinum toxin yields better results than delayed institution (hemispasticity).