Botulinum Toxin as a Stand-Alone Treatment for Muscle Spasticity: Review of the Evidence

Several randomised controlled trials [1-4] have shown that botulinum toxin (BoNT) type A and type B reduce muscle tone as measured with the modified Ashworth scale, reduce the frequency of muscle spasms and pain, increase the joints range of motion and improve motor function in patients with muscle spasticity. The duration of benefit is usually 16 weeks and the beneficial effect is often maintained with repeated treatment cycles [5]. However, preliminary evidence from animal experiments suggests that the treatment effect may be enhanced by combining BoNT with other spasticity treatments but there is insufficient clinical evidence for this. Nonetheless, some guidelines on the management of spasticity recommend that botulinum toxin is used only as an adjunct to other treatment modalities, such as physiotherapy.