Botulinum toxin treatment of adult spasticity

Spasticity is a common complication of CNS injury and a cause of considerable discomfort and disability for the patient and difficulty for caregivers. It is estimated that over half a million people in the USA are affected by spasticity. In recent years, advances in the treatment of spasticity include the use of intrathecal baclofen, addition of tizanidine to oral medication and the introduction of intramuscular botulinum toxin injections. This review aims to give an overview of one of those advances, the use of botulinum toxin. The term spasticity refers only to a type of increased muscle tone due to overactive stretch reflexes, but there are other forms of muscle overactivity that follow brain or spinal cord injury which cause problems. Generally, however, the clinical picture is dominated by the neurological deficits that result from CNS injury. A useful concept in understanding the motor consequences of injury to the CNS is that of the upper motor neuron syndrome.