Aim. Botulinum toxin type A (BTX-A) application in the treatment of post-stroke spasticity or the upper limb was presented.
Review. BTX-A is a valuable tool in the treatment of spasticity due to cerebral palsy, cerebral injuries and stroke. Since the first publication in 1989 many open-label uncontrolled trials have evidenced BTX-A efficacy in decreasing muscle tone, associated pain and muscle spasms, increasing the passive range of motions, facilitating the hygiene, dressing, and in same studies also improving the upper limb function. However, placebo-controlled studies published so far have not revealed any clear impact of BTX-A injections on the complex functions of the upper limb. This may result from too strict protocols, insufficient sensitivity of outcome measures, or too late recruitment to the study (the risk of contractions). The treatment goals, best candidate characteristics, common patterns of spasticity with muscles involved, dose ranges, dose modifiers and the technique of infection under EMG guidance are discussed in the article.