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Botulinum toxin A for post-stroke spasticity: Insights from the French National Hospital Discharge Database
Djamel Bensmail1,2, Anne Forestier3, Jean-Yves Loze3
1Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital AP-HP, Université Paris-Saclay, Garches, France.
European Stroke Journal
|September 19, 2025
Summary
Botulinum neurotoxin type A (BoNT-A) use for post-stroke spasticity in France remains low. Enhancing access and adherence to BoNT-A therapy is crucial for optimizing patient outcomes.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Pharmacology
Background:
- Botulinum neurotoxin type A (BoNT-A) is an established treatment for post-stroke spasticity.
- Real-world utilization patterns of BoNT-A for post-stroke spasticity in France are not well-documented.
Purpose of the Study:
- To evaluate the trends in BoNT-A utilization among stroke survivors in France between 2015 and 2023.
- To analyze BoNT-A treatment rates based on patient demographics and care pathways.
Main Methods:
- Retrospective cohort study utilizing the French National Hospital Discharge Database.
- Analysis of stroke hospitalizations and BoNT-A treatment rates, stratified by age and care pathway.
- Estimation of post-stroke spasticity prevalence, BoNT-A use, and treatment timing in a cohort surviving beyond six months post-stroke.
Main Results:
- BoNT-A treatment rates for post-stroke spasticity remained low, ranging from 1.4% to 1.9% between 2015 and 2022.
- Higher BoNT-A utilization was observed in younger adults (20-29 years) and patients managed in neurovascular or neurorehabilitation units.
- The median time from stroke onset to spasticity coding was 96 days, and to the first BoNT-A injection was 258 days.
Conclusions:
- Botulinum neurotoxin type A (BoNT-A) is significantly underutilized for managing post-stroke spasticity in France.
- There is a critical need to improve access to and adherence to BoNT-A therapy to optimize care for stroke survivors.
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