Chinese Expert Consensus on Botulinum Toxin Injection for the Treatment of Disabling Spasticity in Adults

This expert consensus aims to update current knowledge and techniques and to provide recommendations for key aspects of botulinum toxin (BT) injection in adults with spasticity.

A consensus advisory committee consisting of 6 rehabilitation medicine experts, 6 neurology experts, and 1 statistician from the Neurotoxin Branch of the Chinese Neuroscience Society (NTCNS) formulated recommendations, evidence levels, and recommendation strengths with reference to the GRADE approach and drafted a preliminary consensus. The draft was distributed online to members of the NTCNS with clinical experience in spasticity management (n = 38). Information on experts' clinical practice and their agreement with the proposed recommendations was used to form the final consensus. A recommendation was considered to have reached consensus when more than 75% of respondents with a definite opinion agreed or partially agreed; responses of "uncertain" were excluded from the denominator.

Among the 26 recommendations, 1 was supported by GRADE A evidence, 5 by GRADE B evidence, 8 by GRADE C evidence, and 12 by GRADE D evidence. Six recommendations were strong, 14 were weak, and 6 were neutral positions. Thirty-eight experts completed the survey.

This consensus supports the rational use of BT injection for adult disabling spasticity and provides a decision-making basis for primary care and specialist physicians regarding BT treatment for spasticity caused by different diseases, selection and attainment of treatment goals, common upper- and lower-limb manifestations and injection dose ranges, timing and repetition of BT injection, injection guidance techniques, combined treatment and other treatment options, diagnostic nerve blocks, and cost-effectiveness.