Effect of intramuscular botulinum toxin injection on upper limb spasticity in stroke patients

Am J Phys Med Rehabil. 2002 Apr;81(4):272-8. doi: 10.1097/00002060-200204000-00005.


Objective: To evaluate the therapeutic effect of intramuscular injection of botulinum toxin on spasticity of the upper limb, with emphasis on its influence over limb function.

Design: An open-label, noncontrolled trial with a duration of 12 wk was designed to determine the safety and efficacy of intramuscular botulinum toxin A injection in the treatment of 16 patients with stroke with spastic hemiparesis. Electromyographically guided intramuscular botulinum toxin A injections were applied to the spastic limbs. A detailed scale system was used for the evaluation of muscle tone and functional changes induced by botulinum toxin A treatment.

Results: No major side effect secondary to botulinum toxin A injection was reported. Statistically significant (P < 0.05) improvements of muscle tone, joint range of motion, hand muscle strength, and muscular pain were seen after the injection. The improvements lasted up to 8-12 wk after the treatment. However, there was no significant functional improvement except in two of the patients.

Conclusions: Botulinum toxin A injection may help relieve upper limb spasticity and pain in patients with stroke. Its effect on function is probably determined by case selection.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Arm*
  • Botulinum Toxins, Type A / pharmacology
  • Botulinum Toxins, Type A / therapeutic use*
  • Female
  • Hand Strength
  • Humans
  • Injections, Intramuscular
  • Male
  • Middle Aged
  • Neuromuscular Agents / pharmacology
  • Neuromuscular Agents / therapeutic use*
  • Paraparesis, Spastic / drug therapy*
  • Paraparesis, Spastic / etiology
  • Range of Motion, Articular / drug effects
  • Statistics, Nonparametric
  • Stroke / complications
  • Stroke Rehabilitation*


  • Neuromuscular Agents
  • Botulinum Toxins, Type A