Neurological disorders and botulinum toxin therapy

Abstract

Botulinum toxin injection improves abnormal posture and limited range of motion associated with spasticity. Botulinum toxin therapy has been approved for post–stroke spasticity. It can also be used to treat limb spasticity in cerebral palsy, multiple sclerosis, hereditary spastic paraplegia, lower limb spasticity in HTLV–1–associated myelopathy (HAM), and upper limb spasticity in corticobasal syndrome (CBS). In order to inject the muscles safely and accurately, it is recommended to use ultrasound, electromyography, or electrical stimulation. Because the effects of botulinum toxin diminish 3 to 4 months after infection, it is often repeated to increase the therapeutic efficacy. Adverse events of the treatment include pain, bleeding, and weakness due to overdosage, but serious side effects are rare and can be safely repeated. Rehabilitation after botulinum toxin injection is extremely important to achieve efficacy, and collaboration with physical and occupational therapists is essential.