Abstract
Spasticity is characterized by a velocity-dependent increase in muscle tone. Spasticity can be divided into three groups according to the level of affection: generalized, multifocal, and focal.
Two different types of spasticity can be discerned according to localization of the lesion: 1) spasticity of cerebral origin (mostly developing after stroke); and 2) spasticity of spinal origin (typically in multiple sclerosis, spinal cord injury, degenerative disorder of the spinal canal). Physical therapy is used in all spastic patients.
In patients with uncontrolled intractable spasticity, after common physical therapy it is important to discuss new possibilities of spasticity management. In patients with generalized spasticity, myorelaxation is used in the first place.
In patients with focal or multifocal spasticity, botulinum toxin administration into spastic muscle is recommended. Botulinum toxin injection in superficially located large muscles is a relatively simple technique, however, infiltration to deeply located muscles is recommended through EMG guidance or stimulation of the muscle itself by hollow EMG electrode.
Currently, two types of botulinum toxin and three commercial products for spasticity treatment are available.