Spasticity is a motor symptom characterized by an increase in velocity-dependent stretch

reflexes, with exaggerated tendon jerks. These results from hyperexcitability of the stretch
reflex, as one component of the upper motor neuron syndrome [1]. Spasticity is associated
with various neurological disorders and contributes to functional motor disability/impairment,
pain, and discomfort [2]. Upper limb spasticity is most often caused by stroke or traumatic
brain injury, which can affect the patient’s activities of daily life. The spasticity resulting
from these injuries has a generally similar clinical presentation, often affecting one limb
(monoplegia) and being generally stable (in severity) over time.
Despite the extensive research investigating potential treatments for spasticity, there is
limited information on the incidence and prevalence of spasticity, most likely due to the lack
of consistent definitions and reliable measurement of spastic hypertonia. Further, spasticity
can change over time, with limb position, noxious stimuli, or even in a daily cycle, making an
accurate assessment of incidence challenging [3]. In the United States (US), the annual
incidence rate of stroke is 183 per 100,000, while in Europe it is 113 per 100,000 subjects [3].
The prevalence of spasticity after stroke is in the range of 17 to 38% [4,5,6,7], while
estimates of the prevalence of disabling spasticity range from 4% [4] to over 10% [7].
Disabling spasticity after a stroke occurs more frequently in the upper limb than in the lower
limb [4]. Only a small minority (approximately 5% of subjects) regain useful function of the
paralyzed arm, and the prospects of recovery after the first 3 months after the stroke are
negligible [8,9].

Management of spasticity has involved oral antispastic drugs (benzodiazepines, baclofen,

dantrolene), perineural phenol or alcohol injections, and intrathecal administration of
baclofen. In addition, physiotherapy functional electrical stimulation and splints or casts are
used to stimulate or stretch muscles and minimize soft tissue contractures. Ultimately, the
most severely affected subjects may be treated by orthopedic or neurological surgery. None
of these methods has been completely effective. Further, the use of systemic treatments may
cause significant side effects and may not be effective [10].
The most effective approach for the treatment of spasticity may combine physiotherapy and
intramuscular (i.m.) injections of botulinum toxin type A (BTX A) [11]. Botulinum Toxin
(BTXs) has been used effectively in the treatment of poststroke subjects to decrease muscle
spasticity and muscle tone. Relieving the symptoms of spasticity allows for ongoing
rehabilitation to mobilize the affected area, and to limit or avoid a resultant loss of function.