Abstract illustration symbolizing improved mobility through effective spasticity treatment.

Decoding Spasticity: New Insights and Treatments for Improved Quality of Life

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Kai Mendoza in Health & Wellness October 2026 • 4 min read.

"Explore the latest research on spasticity management, from innovative therapies to real-world data analysis, helping patients and clinicians achieve better outcomes."


Spasticity, a condition characterized by increased muscle tone, affects millions worldwide, often resulting from neurological disorders such as stroke, traumatic brain injury (TBI), cerebral palsy, and multiple sclerosis. Managing spasticity effectively is crucial for improving patients' quality of life, enabling better function, reducing pain, and preventing complications like contractures.

Recent research has focused on refining treatment strategies and understanding the diverse presentations of spasticity. These advancements include exploring the efficacy of botulinum toxin injections, analyzing patient outcomes through comprehensive registries, and identifying potential biomarkers for recovery. By integrating clinical insights with patient-reported outcomes, healthcare professionals can tailor interventions to meet individual needs.

This article delves into the latest findings presented at leading medical conferences, offering a comprehensive overview of current approaches in spasticity management. From observational studies examining the utilization of botulinum toxin to innovative research identifying metabolic markers for recovery after stroke, we aim to provide valuable information for both clinicians and patients navigating the complexities of spasticity.

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Measuring Botulinum Toxin Outcomes

Research evaluating botulinum toxin for spasticity has used the Modified Ashworth Scale to compare treatment with control conditions. The reported analyses calculate standardized mean differences and corresponding 95% confidence intervals. The studies describe statistical processing with STATA 15, while a 2026 retrospective study specifically compares Botulinum Toxin Type A injection patterns and dosages in multiple sclerosis and post-stroke spasticity.

Dosing and Combined Care

Consensus guidance describes botulinum toxin therapy through treatment algorithms, injection schemes, dosing tables, target muscles, total doses, interinjection intervals, and guidance techniques. Its dosing framework distinguishes typical doses from minimum and maximum doses documented in reference-centre treatment data. An overview published in 2024 reports that Botulinum toxin type A injections can improve different types of spasticity. When BoNT-A is not sufficient, the overview states that combining it with nonpharmacological approaches may be attempted.

From Poison to Medicine

The documented history of botulinum toxin reaches back to food-poisoning outbreaks and changing food preparation, storage, and canning practices. The sources place the earliest historical context differently: one traces outbreaks to the tenth century, while another emphasizes outbreaks across Europe and the United States beginning in the late 1700s. The U.S. Food and Drug Administration first approved botulinum toxin in 1989 for treating blepharospasm and strabismus.

Upper Limb Spasticity: Tailoring Treatment for Optimal Outcomes

Abstract illustration symbolizing improved mobility through effective spasticity treatment.

The Upper Limb International Spasticity (ULIS) program, comprising observational cohort studies, provides valuable insights into real-world clinical practices and patient outcomes. ULIS-II focused on a single treatment cycle in stroke patients, while ULIS-III examined repeated cycles across various neurological conditions. These studies highlight the importance of understanding patient-specific goals, such as pain reduction, improved function, and contracture prevention, to guide treatment decisions.

In ULIS-II, pain was the primary goal for 13.4% of patients, with the remaining patients targeting function, mobility, and contracture prevention. Interestingly, the pain group, despite being older and having more severe contractures, showed slightly better primary goal achievement (83.6% vs. 78.9%). This underscores the significance of addressing pain as a primary focus in spasticity management.

  • Key Findings from ULIS Studies:
  • Pain reduction is a crucial goal, irrespective of chronicity or contractures.
  • Patient-reported outcomes, like the pain visual analogue scale, correlate with treatment success.
  • Proximal spasticity improvement is associated with overall patient benefit.
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Current Evidence and Uncertainty

The NICE economic model estimates that post-stroke spasticity occurs in 17% to 43% of people after stroke, corresponding to approximately 17,000 to 43,000 people each year. Its analysis asks how clinically and cost-effective botulinum toxin A is for reducing post-stroke spasticity. These estimates frame the potential population and economic relevance of treatment.

Limits of Long-Term Evidence

Long-term outcomes remain a significant limitation in evidence on botulinum toxin for post-stroke spasticity. One network meta-analysis reports that most included trials followed participants for no more than three months. A systematic review of botulinum toxin combined with rehabilitation concludes that evidence after stroke is insufficient and that the combined effect is limited, although BoNT-A may help improve motor function. Together, these findings support caution about assuming short-term treatment effects translate into durable functional gains.

Real-World Dosing Comparisons

Consensus dosing tables were based on statistical analyses of real-life treatment data. The dataset included 1,831 botulinum toxin injections across 36 target muscles in 420 patients with dystonia and 1,593 injections across 31 target muscles in 240 patients with spasticity. This approach provides a treatment-data basis for comparing doses across target muscles and conditions.

Furthermore, data from ULIS-III reinforce that pain remains a significant target, with 25% of patients identifying it as their primary goal. These findings emphasize that clinicians and patients increasingly recognize pain management as integral to spasticity treatment, regardless of the underlying neurological condition.

The Future of Spasticity Management

Advancements in spasticity management are continuously evolving, driven by clinical studies, real-world data, and innovative research. By prioritizing patient-centered goals and integrating comprehensive assessment tools, healthcare professionals can tailor treatments to optimize outcomes and enhance the quality of life for individuals living with spasticity.

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Maintaining Treatment Over Time

A 2026 study reports that botulinum neurotoxin is safe and effective for spasticity, yet treatment discontinuation is common. The study focuses on factors influencing long-term maintenance of botulinum neurotoxin therapy among people with spasticity. Its research question highlights that treatment effectiveness does not by itself ensure continued therapy.

Adherence and Patient Experience

The ASPIRE analyses examine real-world adherence to onabotulinumtoxinA treatment. They identify patient and clinical variables that affect adherence and provide information intended to optimize management strategies and patient care. This perspective emphasizes that treatment outcomes depend not only on clinical treatment but also on whether patients can remain engaged with therapy.

What the treatment comparisons show in measured terms

  • 167, 322, and 540In the chronic-stroke dose comparison, the medium-dose group received 322 U and was reported effective and safe for PLES; the high-dose group had the most adverse effects in the four weeks after treatment. The compared doses were 167 U, 322 U, and 540 U, alongside placebo.[1]

What the results add, and what they do not establish

The ankle-score comparison indicates a greater measured change with BoNTA than with placebo in that trial. It describes a score change, not by itself the effect on daily function or how long any benefit lasts.[2]

The upper-limb results distinguish treatment paired with rehabilitation from treatment without it: improvement was reported in the former group, not the latter. These scores do not isolate which parts of rehabilitation produced the difference.[3]

How the comparisons and clinical context fit together

The dose review reports a favorable safety and efficacy finding for its medium-dose group, while the high-dose group had the most adverse effects during the stated follow-up. This is a comparison within chronic-stroke participants, not a general dosing rule.[1]

A separate onabotulinumtoxinA comparison also reports a greater MAS change than placebo in its overall population. Together, these findings concern measured tone scores and do not establish that score changes necessarily translate into lasting functional gains.[4]

The clinical guideline places intramuscular botulinum toxin within specialist multidisciplinary care and describes accompanying rehabilitation therapy, splinting, or casting after injections. This is a scope statement about the people and care context it addresses, not a comparative outcome result.[5]

What remains unresolved in the evidence

  • Do measured changes in spasticity scores correspond to durable improvements in movement or everyday function? The reported score comparisons do not answer that question on their own.[2] [4]

Terms used in the measurements

SNAP-25
A synaptosome-associated protein cleaved by the toxin’s light chain.[2]
Ashworth Scale (AS)
An assessment tool that quantifies general resistance to passive stretch at rest.[6]

Sources

  1. Efficacy and Optimal Dose of Botulinum Toxin A in Post-Stroke Lower Extremity Spasticity: A Systematic Review and Meta-Analysis (pmc.ncbi.nlm.nih.gov)
  2. Botulinum toxin type A in post-stroke lower limb spasticity: a multicenter, double-blind, placebo-controlled trial (pmc.ncbi.nlm.nih.gov)
  3. Rehabilitation plus OnabotulinumtoxinA Improves Motor Function over OnabotulinumtoxinA Alone in Post-Stroke Upper Limb Spasticity: A Single-Blind, Randomized Trial (pmc.ncbi.nlm.nih.gov)
  4. Impact of early intervention with onabotulinumtoxinA treatment in adult patients with post-stroke lower limb spasticity: results from the double-blind, placebo-controlled, phase 3 REFLEX study (pmc.ncbi.nlm.nih.gov)
  5. Rehabilitation and recovery - motor recovery and physical effects of stroke - National Clinical Guideline for Stroke (www.strokeguideline.org)
  6. Clinical Outcome Assessments for Spasticity: Review, Critique, and Recommendations (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What exactly is spasticity, and why is managing it so important?

Spasticity is a condition where there is increased muscle tone, often resulting from neurological disorders like stroke, traumatic brain injury (TBI), cerebral palsy, and multiple sclerosis. Effectively managing spasticity is important because it can improve a patient's quality of life, allow for better physical function, reduce pain, and prevent complications such as contractures, which are the tightening of muscles or tendons that can limit movement.

2

How are botulinum toxin injections used in spasticity treatment, and what role do clinical studies play?

Botulinum toxin injections are a treatment approach used to manage spasticity. Clinical studies and real-world data are used to examine how effective these injections are for patients. Understanding patient outcomes through registries and identifying biomarkers can help tailor these and other interventions to meet the specific needs of individuals dealing with spasticity. This personalized approach is key to better outcomes.

3

What is the Upper Limb International Spasticity (ULIS) program, and how does it contribute to managing spasticity?

The Upper Limb International Spasticity (ULIS) program consists of observational cohort studies that provide insights into real-world clinical practices and patient outcomes related to spasticity. These studies, like ULIS-II and ULIS-III, help to understand patient-specific goals, such as reducing pain, improving function, and preventing contractures. The data gathered is used to guide treatment decisions and improve patient care.

4

Why is pain reduction so important in the treatment of spasticity?

Pain reduction is a crucial consideration in spasticity management, as highlighted by the Upper Limb International Spasticity (ULIS) studies. Regardless of how long a person has had spasticity or the presence of contractures, addressing pain can significantly improve treatment success. Patient-reported outcomes, like the pain visual analogue scale, are used to assess treatment effectiveness, indicating that pain management is integral to overall care.

5

What does the future hold for managing spasticity, and what advancements are being made?

The future of spasticity management is focused on advancements driven by clinical studies, real-world data, and innovative research. By prioritizing patient-centered goals and using comprehensive assessment tools, healthcare professionals can tailor treatments to optimize outcomes and improve the quality of life for individuals living with spasticity. This includes ongoing work in areas such as biomarkers and personalized treatment plans.

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