Management of spasticity in adults: practical application of botulinum toxin

Spasticity, characterized by increased muscle tone, exaggerated stretch reflexes, and abnormal limb posture, is a common sequel of central nervous system pathology. Historically, medicinal treatments have been of limited efficacy. This review discusses the clinical features of spasticity, the functional and pathological consequences, and treatment. It reviews the most common patterns of spasticity encountered in the upper and lower limbs and focuses on focal treatment of spastic muscles with the three commercially available botulinum toxins Botox (R), Dysport (R), and Myobloc (R)/NeuroBloc (R). It addresses practical details such as muscle selection and identification, drug dilution, and doses.