Spasticity in adults: management using Botulinum toxin

National guidelines
Royal College of Physicians Jan 2009

The RCP has brought out guidelines for the use of botulinum toxin in adult spasticity.  The guidelines include recommendations for the use of electrical stimulation as an adjunct to botulinum toxin treatment.

5.8.1 Physical management
The team members involved in pre-injection assessment should be included in the post injection treatment, measurement of outcome, re-assessment and review of goal achievement. It is important to:

• Consider other treatments that may enhance the effects of BT (Botulinum Toxin) such as constraint therapy or electrical stimulation as appropriate

• Active NMJs (Neuro – Muscular Junctions) take up BT more avidly than NMJs at rest, and there is some evidence that electrical stimulation of the injected muscle may enhance the anti-spastic effects of BT (Hesse et al 1998). However, it is necessary to stimulate the motor point or the nerve to the muscle, in order to activate the NMJs to achieve this effect

• Functional electrical stimulation of the antagonist muscle may help to build up muscle strength and so enhance functional benefits (Hesse et al 1998).

The full guidelines can be seen at: http://www.rcplondon.ac.uk/publications/Pages/publications.aspx