European consensus statement on the use of botulinum toxin type A in the management of adult spasticity.

Spasticity commonly follows damage to the central nervous system (brain and spinal cord) and presents in conditions, such as stroke, brain and spinal injury of traumatic and non-traumatic causes, multiple sclerosis, cerebral palsy and in a variety of ways depending on the size, location and age of the lesion. It is an involuntary muscle overactivity, which may have several harmful effects such as pain, deformity and impaired function. Botulinum toxin type A is a highly effective treatment in the management of spasticity and has an innovative role where the clinical goals are focal. There is now considerably well documented experience of its use and knowledge of its indications, effects and safety in clinical practice. At a European level there are differences in the management of spasticity from one country to another, particularly in the provision of services. However, there are some basic recommendations on the use of BTX-A in spasticity, which are applicable to all patients and will help promote best practice. A panel of European specialists who have extensive clinical experience on the use of BTX-A in spasticity recently reviewed the wide body of clinical evidence to develop the following recommendations :