High doses of incobotulinumtoxinA for the treatment of post-stroke spasticity: are they safe and effective?

Botulinum toxin type A (BoNT-A) represents the gold standard therapy for focal spasticity and related disorders also in acquired brain injury including stroke. Since 1989, the effectiveness of BoNT-A in reducing poststroke spasticity showed reversibility and low prevalence of complications, obtaining the approval of U.S. Food and Drug Administration for upper limb spasticity after stroke in 2010. In the following years, many studies have been published demonstrating its safety and effectiveness [2,3]. However, the role of BoNT-A in the management of poststroke spasticity has been modified, changing from muscle chemodenervation (nerve block) to become an useful tool for improving limb posture, applying splint, consenting hygiene, standing, and walking in patients with spastic equino-varus foot deformities with also improvement joint range of motion and muscle extensibility or reduction of spasticity-related pain.