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This study established expert consensus on onabotulinumtoxinA treatment paradigms for common poststroke lower limb spasticity postures. The findings provide guidance for optimizing care and improving patient outcomes in managing spasticity.

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Area of Science:

  • Neurology
  • Physical Medicine and Rehabilitation
  • Medical Treatments

Background:

  • OnabotulinumtoxinA is approved for adult upper and lower limb spasticity.
  • Existing guidance exists for upper limb spasticity but not for lower limb spasticity.
  • Poststroke lower limb spasticity (PSLLS) requires standardized treatment paradigms.

Purpose of the Study:

  • To define a consensus-based treatment paradigm for onabotulinumtoxinA in PSLLS.
  • To identify the most common aggregate postures associated with PSLLS.
  • To provide guidance for clinicians, particularly those with less experience.

Main Methods:

  • A modified Delphi consensus process involving ten expert clinicians.
  • Anonymous voting rounds (survey and in-person meeting) until consensus (≥66% agreement) was reached.
  • Recommendations covered muscle selection, dosage, injection sites, dilution, and localization techniques.

Main Results:

  • Consensus was achieved on targeted muscles and dosages for common PSLLS postures.
  • Recommended starting doses for aggregate postures ranged from 300 to 400 U.
  • OnabotulinumtoxinA dilution of 50 U/mL was favored, with adjustments for specific muscles.

Conclusions:

  • The Delphi process successfully established consensus on onabotulinumtoxinA treatment paradigms for PSLLS postures.
  • These consensus-based recommendations can optimize care delivery for patients with PSLLS.
  • The findings offer valuable guidance for the effective use of onabotulinumtoxinA in managing lower limb spasticity.