[Treatment of spasticity with botulinum toxin]

The beneficial effects of rehabilitation are known to plateau around 6 months after stroke. But there are some reports that motor functions are improved with using botulinum neurotoxin A (BoNT-A) for limb spasticity in the maintenance stage of stroke. Though it has been thought that BoNT-A works in the peripheral nerves so far, Caleo showed BoNT-A can affect the central nervous system. We suspected BoNT-A affected the spinal cord directly following retrograde transsynaptic transport from his reports. We deduce the abnormal stretch reflex is made a modification by affecting the spinal cord, and it follows that motor function.We suggest it is important BoNT-A injection immediately followed by intensive rehabilitation to regain active motor function, because BoNT-A has a specific affinity to cleave certain proteins involved in the mechanism of acetylcholine exocytosis. We propose BoNT-A treatment at 3-month interval should be set.