, Volume 79, Issue 2, pp 143–160 | Cite as

Botulinum Toxin Type A for the Treatment of Lower Limb Spasticity after Stroke

  • Andrea SantamatoEmail author
  • Nicoletta Cinone
  • Francesco Panza
  • Sara Letizia
  • Luigi Santoro
  • Madia Lozupone
  • Antonio Daniele
  • Alessandro Picelli
  • Alessio Baricich
  • Domenico Intiso
  • Maurizio Ranieri
Review Article


Post-stroke lower limb spasticity impairs balance and gait leading to reduced walking speed, often increasing wheelchair use and caregiver burden. Several studies have shown that appropriate treatments for lower limb spasticity after stroke include injections of botulinum toxin type A (BoNT-A), phenol or alcohol, surgical correction and a rehabilitation program. In the present article, we review the safety and effectiveness of BoNT-A for the treatment of lower limb spasticity after stroke, with a focus on higher doses of BoNT-A. The cumulative body of evidence coming from the randomized clinical trials and open-label studies selected in the article suggest BoNT-A to be safe and efficacious in reducing lower limb spasticity after stroke. Studies of high doses of BoNT-A also showed a greater reduction of severe post-stroke spasticity. In stroke survivors with spasticity of the ankle plantar-flexor muscles, a combined approach between surgery and BoNT-A can be indicated. However, controversy remains about improvement in motor function relative to post-stroke spasticity reduction after BoNT-A treatment.


Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this study.

Conflicts of interest

Andrea Santamato, Nicoletta Cinone, Francesco Panza, Sara Letizia, Luigi Santoro, Madia Lozupone, Antonio Daniele, Alessandro Picelli, Alessio Baricich, Domenico Intiso, and Maurizio Ranieri have no conflicts of interest that are directly relevant to the content of this study.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Andrea Santamato
    • 1
    • 2
    Email author
  • Nicoletta Cinone
    • 1
  • Francesco Panza
    • 3
    • 4
    • 5
  • Sara Letizia
    • 1
  • Luigi Santoro
    • 1
  • Madia Lozupone
    • 3
  • Antonio Daniele
    • 6
    • 7
  • Alessandro Picelli
    • 8
    • 9
  • Alessio Baricich
    • 10
  • Domenico Intiso
    • 11
  • Maurizio Ranieri
    • 1
  1. 1.Physical Medicine and Rehabilitation Section, “OORR Hospital”University of FoggiaFoggiaItaly
  2. 2.“Fondazione Turati” Rehabilitation CentreViesteItaly
  3. 3.Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense OrgansUniversity of Bari “Aldo Moro”BariItaly
  4. 4.Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari “Aldo Moro”TricaseItaly
  5. 5.Geriatric UnitFondazione IRCCS “Casa Sollievo della Sofferenza”San Giovanni RotondoItaly
  6. 6.Institute of NeurologyCatholic University of Sacred HeartRomeItaly
  7. 7.Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  8. 8.Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research CenterUniversity of VeronaVeronaItaly
  9. 9.Neurorehabilitation Unit, Department of NeurosciencesHospital Trust of VeronaVeronaItaly
  10. 10.Health Sciences DepartmentUniversità del Piemonte OrientaleNovaraItaly
  11. 11.Department of Neuro-Rehabilitation IRCCSCasa Sollievo della SofferenzaSan Giovanni RotondoItaly

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