Botulinum neurotoxin intramuscular chemodenervation. Role in the management of spastic hypertonia and related motor disorders.

There is a range of interventions available in the management of spastic hypertonia among patients with central nervous system injury. Many of these treatment options can be used concurrently with great effectiveness. Although manifestations of spastic hypertonia vary from patient to patient, they usually are not limited to one site. Nevertheless, problematic spastic muscle overactivity may be localized to one or more specific extremities, and these may be referred to as examples of focal dysfunctional spasticity. Botulinum neurotoxin (BTX) intramuscular chemodenervation procedures are an important therapeutic technique in focal spasticity management. Magnitude and duration of response varies with successful selection and localization of targeted muscles, spasticity severity, BTX dosage, and chosen functional goals. In focal dysfunctional spasticity and related motor disorders, BTX injections have demonstrated efficacy and safety when performed by clinicians familiar with the agent, regional anatomy, the specific condition, and patient being treated.