Botulinum Toxin Therapy for Treatment of Spasticity in Multiple Sclerosis: Review and Recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders Task Force

J Neurol. 2017 Jan;264(1):112-120. doi: 10.1007/s00415-016-8304-z. Epub 2016 Oct 27.


Botulinum toxin (BT) therapy is an established treatment of spasticity due to stroke. For multiple sclerosis (MS) spasticity this is not the case. IAB-Interdisciplinary Working Group for Movement Disorders formed a task force to explore the use of BT therapy for treatment of MS spasticity. A formalised PubMed literature search produced 55 publications (3 randomised controlled trials, 3 interventional studies, 11 observational studies, 2 case studies, 35 reviews, 1 guideline) all unanimously favouring the use of BT therapy for MS spasticity. There is no reason to believe that BT should be less effective and safe in MS spasticity than it is in stroke spasticity. Recommendations include an update of the current prevalence of MS spasticity and its clinical features according to classifications used in movement disorders. Immunological data on MS patients already treated should be analysed with respect to frequencies of MS relapses and BT antibody formation. Registration authorities should expand registration of BT therapy for spasticity regardless of its aetiology. MS specialists should consider BT therapy for symptomatic treatment of spasticity.

Keywords: Botulinum toxin; IAB-Interdisciplinary Working Group for Movement Disorders; Multiple sclerosis; Recommendations; Review; Spasticity; Therapeutic use.

Publication types

  • Guideline
  • Review

MeSH terms

  • Acetylcholine Release Inhibitors / therapeutic use*
  • Botulinum Toxins / therapeutic use*
  • Humans
  • Multiple Sclerosis / classification
  • Multiple Sclerosis / complications*
  • Multiple Sclerosis / drug therapy
  • Multiple Sclerosis / physiopathology
  • Muscle Spasticity / classification
  • Muscle Spasticity / drug therapy*
  • Muscle Spasticity / etiology*
  • Muscle Spasticity / physiopathology


  • Acetylcholine Release Inhibitors
  • Botulinum Toxins