, Volume 77, Issue 13, pp 1413–1422 | Cite as

Benefits and Risks of Non-Approved Injection Regimens for Botulinum Toxins in Spasticity

  • Andrea SantamatoEmail author
  • Francesco Panza
Review Article


Spasticity with muscle paresis and loss of dexterity is a common feature of upper motor neuron syndrome due to injuries or the pyramidal tract in several neurological conditions. Botulinum toxin type A has been considered the gold standard treatment for spasticity and movement disorders, with efficacy, reversibility, and low prevalence of complications. During the last 30 years, thousands of studies of its use have been performed, but few guidelines are available. Therefore, there is great variability in both the doses and intervals of administration and the approaches taken by clinicians with considerable experience in spasticity and movement disorder treatment. In the present review article, we provide a short overview of the benefits and risks of non-approved injection regimens and doses for botulinum toxins, focusing on the treatment of post-stroke spasticity, where there is great interest in the potential for increasing the number of treatment/years and the dose of botulinum toxin treatment for subjects with upper and lower limb spasticity. However, many doubts exist regarding antibody development and possible adverse effects.



We wish to thank Professor Anthony B. Ward for translation and preparation of the English text.

Compliance with Ethical Standards


Dr. Santamato and Dr. Panza reported no funding for the present paper.

Conflicts of interest

Dr. Santamato and Dr. Panza reported no conflicts of interest. The authors alone are responsible for the content and writing of the paper.


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Physical Medicine and Rehabilitation Section, “OORR Hospital”University of FoggiaFoggiaItaly
  2. 2.“Fondazione Turati” Rehabilitation CentreViesteItaly
  3. 3.Complex Structure of Geriatrics, Department of Medical SciencesIRCCS “Casa Sollievo della Sofferenza”FoggiaItaly
  4. 4.Unit of Neurodegenerative Disease, Department of Basic Medicine Sciences, Neuroscience, and Sense OrgansUniversity of Bari “Aldo Moro”BariItaly
  5. 5.Unit of Neurodegenerative Disease, Department of Clinical Research in NeurologyUniversity of Bari “Aldo Moro” at “Pia Fondazione Card. G. Panico”TricaseItaly

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