Suggested Reading and Resources

Aurora S. Botulinum toxin type A for the treatment of migraine [review]. Expert Opin Pharmacother. 2006;7(8):1085-1095. View abstract

Baird MW, Vargus-Adams J. Outcome measures used in studies of botulinum toxin in childhood cerebral palsy: a systematic review [review]. J Child Neurol. 2010;25(6):721-727. View abstract

Beard S, Hunn A, Wight J. Treatments for spasticity and pain in multiple sclerosis: a systematic review. Health Technol Assess. 2003;7(40):iii, ix-x, 1-111. View abstract

Botox [package insert]. Irvine, CA: Allergan Inc; 2010.

Brashear A, Gordon MF, Elovic E, et al; Botox Post-Stroke Spasticity Study Group. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. N Engl J Med. 2002;347(6):395-400. View abstract

Brashear A, McAfee AL, Kuhn ER, Fyffe J. Botulinum toxin type B in upper-limb poststroke spasticity: a double-blind, placebo-controlled trial. Arch Phys Med Rehabil. 2004;85(5):705-709. View abstract

Brin MF. Dosing, administration, and a treatment algorithm for use of botulinum toxin A for adult-onset spasticity. Muscle Nerve Suppl. 1997;6:S208-S220. View abstract

Cardoso E, Rodrigues B, Lucena R, Reis de Oliveira I, Pedreira G, Melo A. Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: a meta-analysis. Arq Neuropsiquiatr. 2005;63(1):30-33. View abstract

Charles PD. Botulinum neurotoxin serotype A: a clinical update on non-cosmetic uses. Am J Health Syst Pharm. 2004;61(22 suppl 6):S11-S23. View abstract

Cheng CM, Chen JS, Patel RP. Unlabeled uses of botulinum toxins: a review, part 1. Am J Health Syst Pharm. 2006;63(2):145-152. View abstract

Cheng CM, Chen JS, Patel RP. Unlabeled uses of botulinum toxins: a review, part 2. Am J Health Syst Pharm. 2006;63(3):225-232. View abstract

Childers MK. The importance of electromyographic guidance and electrical stimulation for injection of botulinum toxin. Phys Med Rehabil Clin N Am. 2003;14(4):781-792. View abstract

Childers MK. Targeting the neuromuscular junction in skeletal muscles. Am J Phys Med Rehabil. 2004;83(10 suppl):S38-S44. View abstract

Childers MK, Childers MK, Brashear A, et al. Dose-dependent response to intramuscular botulinum toxin type A for upper-limb spasticity in patients after a stroke. Arch Phys Med Rehabil. 2004;85(7):1063-1069. View abstract Dysport studies. Available at: Accessed September 22, 2010. Myobloc studies. Available at: Accessed September 22, 2010. Xeomin studies. Available at: Accessed September 22, 2010.

Coté TR, Mohan AK, Polder JA, Walton MK, Braun MM. Botulinum toxin type A injections: adverse events reported to the US Food and Drug Administration in therapeutic and cosmetic cases. J Am Acad Dermatol. 2005;53(3):407-415. View abstract

Craven BC, Morris AR. Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI. Spinal Cord. 2010;48(3):207-213. View abstract

Crayton HJ, Rossman HS. Managing the symptoms of multiple sclerosis: a multimodal approach. Clin Ther. 2006;28(4):445-460. View abstract

Dajpratham P, Kuptniratsaikul V, Kovindha A, Kuptniratsaikul PS, Dejnuntarat K. Prevalence and management of poststroke spasticity in Thai stroke patients: a multicenter study.  J Med Assoc Thai. 2009;92(10):1354-1360. View abstract

Dario A, Tomei G. A benefit-risk assessment of baclofen in severe spinal spasticity [review]. Drug Saf. 2004;27(11):799-818. View abstract

Davis EC, Barnes MP. Botulinum toxin and spasticity. J Neurol Neurosurg Psychiatry. 2000;69(2):143-147. View abstract

Denny-Brown D. The Cerebral Control of Movement. Liverpool, UK: University Press; 1966:124-143.

Deshpande S, Gormley ME Jr, Carey JR. Muscle fiber orientation in muscles commonly injected with botulinum toxin: an anatomical pilot study. Neurotox Res. 2006;9(2-3):115-120. View abstract

Dolly O. Synaptic transmission: inhibition of neurotransmitter release by botulinum toxins. Headache. 2003;43(suppl 1):S16-S24. View abstract

Dysport [package insert]. Wrexham, UK: Ipsen Biopharm Ltd; 2009.

Elovic EP, Esquenazi A, Alter KE, Lin JL, Alfaro A, Kaelin DL. Chemodenervation and nerve blocks in the diagnosis and management of spasticity and muscle overactivity. PM R. 2009;1(9):842-851. View abstract

Elovic EP, Munin MC, Kaňovský P, Hanschmann A, Hiersemenzel R, Marciniak C.Muscle Nerve. 2015 Jul 22. doi: 10.1002/mus.24776. [Epub ahead of print]]

Esquenazi A. Botulinum neurotoxin in muscle overactivity. J Head Trauma Rehabil. 2005;20(6):563-567. View abstract

Esquenazi A. Evaluation and management of spastic gait in patients with traumatic brain injury. J Head Trauma Rehabil. 2004;19(2):109-118. View abstract

Esquenazi A. Improvements in healthcare and cost benefits associated with botulinum toxin treatment of spasticity and muscle overactivity. Eur J Neurol. 2006;13(suppl 4):27-34. View abstract

Esquenazi A, Mayer N. Botulinum toxin for the management of muscle overactivity and spasticity after stroke. Curr Atheroscler Rep. 2001;3(4):295-298. View abstract

Esquenazi A, Mayer NH. Instrumented assessment of muscle overactivity and spasticity with dynamic polyelectromyographic and motion analysis for treatment planning. Am J Phys Med Rehabil. 2004;83(10 suppl):S19-S29. View abstract

Esquenazi A, Mayer NH. Muscle overactivity in the upper motor neuron syndrome: functional and anatomical considerations [CD-ROM]. New York, NY: The Institute for Medical Studies; 2005.

Faist M, Mazevet D, Dietz V, Pierrot-Deseilligny E. A quantitative assessment of presynaptic inhibition of Ia afferents in spastics : differences in hemiplegics and paraplegics. Brain. 1994;117(Pt 6):1449-1455. View abstract

FDA requires boxed warning for all botulinum toxin products [news release]. Silver Spring, MD: US Food and Drug Administration; April 30, 2009. Available at: Updated January 4, 2010. Accessed September 22, 2010.

Fleuren JF, Voerman GE, Erren-Wolters CV, et al. Stop using the Ashworth scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry. 2010;81(1):46-52. View abstract

Frasson E, Priori A, Ruzzante B, Didonè G, Bertolasi L. Nerve stimulation boosts botulinum toxin action in spasticity. Mov Disord. 2005;20(5):624-629. View abstract

Ghotbi N, Ansari NN, Naghdi S, Hasson S, Jamshidpour B, Amiri S. Inter-rater reliability of the modified Ashworth scale in assessing lower limb muscle spasticity. Brain Inj. 2009;23(10):815-819. View abstract

Gioux M, Petit J. Effects of immobilizing the cat peroneus longus muscle on the activity of its own spindles. J Appl Physiol. 1993;75(6):2629-2635. View abstract

Gorassini MA, Knash ME, Harvey PJ, Bennett DJ, Yang JF. Role of motoneurons in the generation of muscle spasms after spinal cord injury. Brain. 2004;127(Pt 10):2247-2258. View abstract

Gordon MF, Brashear A, Elovic E, et al; BOTOX Poststroke Spasticity Study Group. Repeated dosing of botulinum toxin type A for upper limb spasticity following stroke. Neurology. 2004;63(10):1971-1973. View abstract

Gracies JM. Pathophysiology of impairment in patients with spasticity and use of stretch as a treatment of spastic hypertonia. Phys Med Rehabil Clin N Am. 2001;12(4):747-768, vi. View abstract

Gracies JM. Pathophysiology of spastic paresis. I: paresis and soft tissue changes. Muscle Nerve. 2005;31(5):535-551. View abstract

Gracies JM. Pathophysiology of spastic paresis. II: emergence of muscle overactivity. Muscle Nerve. 2005;31(5):552-571. View abstract

Gracies JM. Physiological effects of botulinum toxin in spasticity. Mov Disord. 2004;19(suppl 8):S120-S128. View abstract

Gracies JM, Elovic E, McGuire J, Simpson D. Traditional pharmacologic treatments of spasticity. Part I: local treatments. In: Mayer NH, Simpson DM, eds. Spasticity: Etiology, Evaluation, Management and the Role of Botulinum Toxin. New York, NY: WE MOVE; 2002:44-64.

Gracies JM, Nance P, Elovic E, McGuire J, Simpson D. Traditional pharmacologic treatments of spasticity. Part II: systemic treatments. In: Mayer NH, Simpson DM, eds. Spasticity: Etiology, Evaluation, Management and the Role of Botulinum Toxin. New York, NY: WE MOVE; 2002:65-93.

Gracies JM, Nance P, Elovic E, McGuire J, Simpson DM. Traditional pharmacological treatments for spasticity. Part II: general and regional treatments. Muscle Nerve Suppl. 1997;6:S92-S120. View abstract

Gracies JM, Simpson DM. Focal injection therapy. In: Hallett M, ed. Movement Disorders: Handbook of Clinical Neurophysiology. St Louis, MO: Elsevier Science BV; 2003:651-695.

Hesse S, Brandi-Hesse B, Bardeleben A, Werner C, Funk M. Botulinum toxin A treatment of adult upper and lower limb spasticity. Drugs Aging. 2001;18(4):255-262. View abstract

Hesse S, Jahnke MT, Luecke D, Mauritz KH. Short-term electrical stimulation enhances the effectiveness of botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients. Neurosci Lett. 1995;201(1):37-40. View abstract

Ivanhoe CB, Reistetter TA. Spasticity: the misunderstood part of the upper motor neuron syndrome. Am J Phys Med Rehabil. 2004;83(10 suppl):S3-S9. View abstract

Jankovic J, Esquenazi A, Fehlings D, Freitag F, Lang AM, Naumann M. Evidence-based review of patient-reported outcomes with botulinum toxin type A. Clin Neuropharmacol. 2004;27(5):234-244. View abstract

Kanovský P, Slawek J, Denes Z, et al. Efficacy and safety of botulinum neurotoxin NT 201 in poststroke upper limb spasticity. Clin Neuropharmacol. 2009;32(5):259-265. View abstract

Keenan MA, Lee GA, Tuckman AS, Esquenazi A. Improving calf muscle strength in patients with spastic equinovarus deformity by transfer of long toe flexors to the Os calcis. J Head Trauma Rehabil. 1999;14(2):163-175. View abstract

Kim HS, Hwang JH, Jeong ST, et al. Effect of muscle activity and botulinum toxin dilution volume on muscle paralysis. Dev Med Child Neurol. 2003;45(3):200-206. View abstract

Kinnett D. Botulinum toxin A injections in children: technique and dosing issues. Am J Phys Med Rehabil. 2004;83(10 suppl):S59-S64. View abstract

Kita M, Goodkin DE. Drugs used to treat spasticity. Drugs. 2000;59(3):487-495. View abstract

Koman LA, Brashear A, Rosenfeld S, et al. Botulinum toxin type A neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multicenter, open-label clinical trial. Pediatrics. 2001;108(5):1062-1071. View abstract

Koman LA, Mooney JF, Smith BP, Walker F, Leon JM; BOTOX Study Group. Botulinum toxin type A neuromuscular blockade in the treatment of lower extremity spasticity in cerebral palsy: a randomized, double-blind, placebo-controlled trial. J Pediatr Orthop. 2000;20(1):108-115. View abstract

Lundström E, Terént A, Borg J. Prevalence of disabling spasticity 1 year after first-ever stroke. Eur J Neurol. 2008;15(6):533-539. View abstract

Lynn AK, Turner M, Chambers HG. Surgical management of spasticity in persons with cerebral palsy [review]. PM R. 2009;1(9):834-838. View abstract

Marchetti A, Magar R, Findley L, et al. Retrospective evaluation of the dose of Dysport and Botox in the management of cervical dystonia and blepharospasm: the REAL DOSE study. Mov Disord. 2005;20(8):937-944. View abstract

Marque P, Simonetta-Moreau M, Maupas E, Roques CF. Facilitation of transmission in heteronymous group II pathways in spastic hemiplegic patients. J Neurol Neurosurg Psychiatry. 2001;70(1):36-42. View abstract

Mayer NH. Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motoneuron lesion [review]. Muscle Nerve Suppl. 1997;6:S1-S13. View abstract

Mayer NH, Esquenazi A. Muscle overactivity and movement dysfunction in the upper motoneuron syndrome. Phys Med Rehabil Clin N Am. 2003;14(4):855-883, vii-viii. View abstract

Mayer NH, Esquenazi A, Childers MK. Common patterns of clinical motor dysfunction. Muscle Nerve Suppl. 1997;6:S21-S35. View abstract

McCrea PH, Eng JJ, Willms R. Phenol reduces hypertonia and enhances strength: a longitudinal case study. Neurorehabil Neural Repair. 2004;18(2):112-116. View abstract

Mejia NI, Vuong KD, Jankovic J. Long-term botulinum toxin efficacy, safety, and immunogenicity. Mov Disord. 2005;20(5):592-597. View abstract

Mohammadi B, Balouch SA, Dengler R, Kollewe K. Long-term treatment of spasticity with botulinum toxin type A: an analysis of 1221 treatments in 137 patients. Neurol Res. 2010;32(3):309-313. View abstract

Morita H, Crone C, Christenhuis D, Petersen NT, Nielsen JB. Modulation of presynaptic inhibition and disynaptic reciprocal Ia inhibition during voluntary movement in spasticity. Brain. 2001;124(Pt 4):826-837. View abstract

Münchau A, Bhatia KP. Uses of botulinum toxin injection in medicine today [review]. BMJ. 2000;320(7228):161-165. View abstract

Myobloc [package insert]. South San Francisco, CA: Solstice Neurosciences LLC; 2009.

Nordmark E, Josenby AL, Lagergren J, Andersson G, Strömblad LG, Westbom L. Long-term outcomes five years after selective dorsal rhizotomy. BMC Pediatr. 2008;8:54. View abstract

O’Brien CF. Injection techniques for botulinum toxin using electromyography and electrical stimulation. Muscle Nerve Suppl. 1997;6:S176-S180. View abstract

O’Brien CF. Treatment of spasticity with botulinum toxin. Clin J Pain. 2002;18(6 suppl):S182-S190. View abstract

O’Dwyer NJ, Ada L, Neilson PD. Spasticity and muscle contracture following stroke. Brain. 1996;119(Pt 5):1737-1749. View abstract

Pathak MS, Nguyen HT, Graham HK, Moore AP. Management of spasticity in adults: practical application of botulinum toxin. Eur J Neurol. 2006;13(suppl 1):42-50. View abstract

Pierrot-Deseilligny E, Bergego C, Katz R. Reversal in cutaneous of Ib pathways during human voluntary reversal in cutaneous of contraction. Brain Res. 1982;233(2):400-403. View abstract

Sampaio C, Costa J, Ferreira JJ. Clinical comparability of marketed formulations of botulinum toxin. Mov Disord. 2004;19(suppl 8):S129-S136. View abstract

Satkunam LE. Rehabilitation medicine: 3. Management of adult spasticity. CMAJ. 2003;169(11):1173-1179. View abstract

Sheean G. The pathophysiology of spasticity. Eur J Neurol. 2002;9(suppl 1):3-9. View abstract

Simpson DM, Alexander DN, O'Brien CF, et al. Botulinum toxin type A in the treatment of upper extremity spasticity: a randomized, double-blind, placebo-controlled trial. Neurology. 1996;46(5):1306-1310. View abstract

Slawek J, Bogucki A, Reclawowicz D. Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualised, flexible injection regimens. Neurol Sci. 2005;26(1):32-39. View abstract

Sommerfeld DK, Eek EU, Svensson AK, Holmqvist LW, von Arbin MH. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke. 2004;35(1):134-139. View abstract

Suputtitada A, Suwanwela NC. The lowest effective dose of botulinum A toxin in adult patients with upper limb spasticity. Disabil Rehabil. 2005;27(4):176-184. View abstract

Synder M, Kumar SJ, Stecyk MD. Split tibialis posterior tendon transfer and tendo-Achillis lengthening for spastic equinovarus feet. J Pediatr Orthop. 1993;13(1):20-23. View abstract

Tilton AH. Injectable neuromuscular blockade in the treatment of spasticity and movement disorders. J Child Neurol. 2003;18(suppl 1):S50-S66. View abstract

Verheyden J, Blitzer A, Brin MF. Other noncosmetic uses of BOTOX. Semin Cutan Med Surg. 2001;20(2):121-126. View abstract

Vitek JL, Giroux M. Physiology of hypokinetic and hyperkinetic movement disorders: model for dyskinesia. Ann Neurol. 2000;47(4 suppl 1):S131-S140. View abstract

Wang HC, Hsieh LF, Chi WC, Lou SM. Effect of intramuscular botulinum toxin injection on upper limb spasticity in stroke patients. Am J Phys Med Rehabil. 2002;81(4):272-278. View abstract

Watkins CL, Leathley MJ, Gregson JM, Moore AP, Smith TL, Sharma AK. Prevalence of spasticity post stroke. Clin Rehabil. 2002;16(5):515-522. View abstract

WE MOVE. Resource library: movement disorders. Available at: Accessed June 18, 2007.

WE MOVE. Spasticity. Available at: Accessed September 22, 2010.

Wenzel R, Jones D, Borrego JA. Comparing two botulinum toxin type A formulations using manufacturers’ product summaries. J Clin Pharm Ther. 2007;32(4):387-402. View abstract

Wissel J, Müller J, Dressnandt J, et al. Management of spasticity associated pain with botulinum toxin A. J Pain Symptom Manage. 2000;20(1):44-49. View abstract

Xeomin [package insert]. Dessau-Rosslau, Germany: Merz Pharmaceuticals LLC; 2010.

Xeomin [package insert]. Germany: Merz Pharmaceuticals; 2010.

Yablon SA. Botulinum neurotoxin intramuscular chemodenervation: role in the management of spastic hypertonia and related motor disorders. Phys Med Rehabil Clin N Am. 2001;12(4):833-874, vii-viii. View abstract

Yablon SA, Agana BT, Ivanhoe CB, Boake C. Botulinum toxin in severe upper extremity spasticity among patients with traumatic brain injury: an open-labeled trial. Neurology. 1996;47(4):939-944. View abstract

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