Spasticity Management is based on a multidisciplinary approach and a comprehensive, individualized rehabilitation program. The treatment of focal and regional spasticity is performed through botulinum toxin injections by a specialized physician (physiatrist or neurologist) under electromyographic guidance. The effectiveness is maximized with the contribution of the physiotherapy, occupational therapy, and orthotics departments of the Center.
The patient is educated on how to manage spasticity and cope with the resulting impairment or disability, aiming to improve their quality of life.
What is Spasticity?
Spasticity is the continuous, involuntary contraction of specific muscle groups of the upper or lower limbs due to damage to the Central Nervous System (CNS).
We have all encountered patients with spasticity following CNS injuries (Stroke, Traumatic Brain Injury, Spinal Cord Injury, Multiple Sclerosis, Muscle Dystonia, Cerebral Palsy, etc.) and seen how distressing it can be, as it causes mobility problems, pain, difficulties in daily hygiene, and injuries due to motor control impairment.
The greatest challenge posed by spasticity is its interference with rehabilitation efforts.
In recent years, patients suffering from focal or regional spasticity are treated with botulinum toxin, which induces local, temporary muscle relaxation, reduces pain, and significantly enhances the effectiveness of physiotherapy, thereby improving overall quality of life and functionality.
It should be emphasized that botulinum toxin achieves optimal results when used in combination with a comprehensive rehabilitation program and when administered at the first signs of spasticity.
If spasticity is long-standing and contractures (permanent muscle dysfunction) have developed, the toxin can only offer pain relief, as its impact on functionality is minimal at this stage.
The advantages of botulinum toxin use include:
- Simple intramuscular administration, without special preparation.
- Minimal and temporary side effects that do not recur with proper dose adjustment.
- Allows reduction or discontinuation of oral medications that are often ineffective in treating spasticity and come with significant side effects such as fatigue, reduced alertness, and gastrointestinal issues. Unlike oral muscle relaxants, botulinum toxin is administered locally via intramuscular injection, affecting only the targeted muscles without systemic side effects.
- Proven reduction in spasticity, enhancing quality of life and significantly supporting rehabilitation, especially physiotherapy and occupational therapy.
How is botulinum toxin administered and how long does it last?
Botulinum toxin inhibits the transmission of nerve impulses to the muscle, causing a local, temporary, and dose-dependent muscle relaxation.
It is administered almost painlessly with a special thin needle-electrode directly into the overactive muscle under electromyographic guidance.
The injection must be performed by a specialized physician familiar with the anatomy of the area and the injection technique. Muscle relaxation becomes noticeable after a few days, lasts 3–4 months, and in some cases up to 6 months, requiring repeat injections at regular intervals.
Administering the toxin in the early stages of spasticity yields better results.
Is botulinum toxin covered by my insurance?
Yes, if prescribed for conditions like dystonia or post-stroke spasticity, with partial patient co-payment. It is not covered for cosmetic purposes.
In which other conditions is botulinum toxin used?
It can be used in any condition with increased muscle tone to reduce both spasm and pain. Botulinum toxin is widely used for:
- Blepharospasm
- Cervical dystonia (torticollis)
- Limb dystonia (e.g., writer’s cramp)
- Hemifacial spasm
- Axillary hyperhidrosis
- Lower limb spasticity due to cerebral palsy in children over 2 years
- Adult spasticity after stroke
Its use is constantly expanding and shows very promising results in managing spasticity in patients after stroke, traumatic brain injury, or multiple sclerosis.
Recently, it has also been used in clinical studies for chronic daily headaches – migraines and in the management of overactive neurogenic bladder, with highly encouraging outcomes.
Goals of Spasticity Management
- Improvement of daily living activities, mobility, caregiver burden, sleep quality, body image, and overall functional independence.
- Prevention of contractures, pressure sores, and the need for corrective surgeries.
- Pain reduction
- Facilitation of stretching shortened muscles, strengthening antagonistic muscles, and proper application of orthotic aids.
Botulinum toxin significantly improves the quality of life of patients suffering from dystonias or spasticity. However, it must be administered by specialized physicians with knowledge of the regional anatomy and injection techniques.
