Pan-Arab consensus statement on the use of botulinum toxin type A in spasticity management.

tendon jerks, resulting from hyperexcitability of the stretch reflex.”1 Spasticity can produce impairment of active functions performed by the patient such as reaching, transferring, and walking, as well as disabling symptoms of pain, spasm, and disfigurement, disturbance in passive functions when the patient is being assisted by a caregiver, such as excessive tone in a limb during washing, bathing, and dressing. Spasticity may also lead to musculoskeletal complications such as contracture, peripheral neuropathy, and heterotopic ossification.5 Management options. Spasticity treatment is best approached in a multi-disciplinary fashion. The goals of and benefits to the patient are very important when considering the path of treatment. Common goals are to decrease pain, prevent or decrease contractures, improve ambulation, facilitate activities of daily living (ADL), facilitate rehabilitation participation, save caregiver’s time, improve the ease of care, and increase safety. Appropriate management choices are based on realistic therapeutic objectives. Both the patient’s and the caregiver’s goals must be considered. Traditional treatments for spasticity include physical and occupational therapy where the patient is stretched from one to several times per day, but this has only limited effect on the patient’s spasticity. Rehabilitation treatment options include casting, orthotics, electrical stimulation, practice of functional tasks, sensory integration, muscle stretching, and targeted muscle training. Oral medications can be used to decrease spasticity, however, many have unwanted side effects such as drowsiness, sedation, confusion, and S is a common and debilitating condition associated with various neurologic disorders such as multiple sclerosis, stroke, cerebral palsy, spinal cord, and brain injury. While the incidence of spasticity is not known with certainty, it is likely that it affects over half a million people in the United States alone, and over 12 million worldwide.1 With the increasing number of available options in managing spasticity and most notably, the considerable increase over the last few years in the use of botulinum toxin type A (BTX-A) as a safe and effective option in spasticity management,2-8 there is an urgent need for a national consensus and guidelines for spasticity management in Arab countries. A group of experts in rehabilitation medicine and neurological sciences representing different Arab countries met in Cairo in May 2005 to evaluate the developing experience with botulinum toxin in the treatment of various clinical disorders characterized by spasticity, and to develop a consensus statement to guide the use of BTX-A in the region. The practice of developing a regional consensus statement for the use of BTX-A in spasticity management has many precedents in North America (National Institutes of Health consensus statement) and Europe (European consensus statement).9,10 In this paper, we provide an overview of spasticity, its current management options, the history of BTX-A use, and describe the consensus statement. Definition and effects of spasticity. Spasticity was defined by Lance as a “velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated