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Spasticity in adults: management using botulinum toxin

These guidelines provide recommendations for the treatment of adults with spasticity with botulinum toxin (BoNT) as part of an overall patient management programme.

BoNT is licensed in the UK for treatment of focal spasticity in the arm and leg. It has also become an accepted part of routine management of spasticity in other muscle groups, such as neck and jaw muscles.

Common goal areas for intervention include:

  • pain relief
  • reduction of involuntary movements (eg associated reactions, spasms)
  • prevention of contractures and deformity
  • passive function (making it easier to care for the affected limb)
  • active function (using the affected limb)
  • mobility.

Further research should focus on the totality of what is a complex intervention, and include the physical interventions often applied with pharmacological interventions such as BoNT, in the management of spasticity.


This updated edition replaces the original guidance published in 2009.

On 11 March 2019 the key definition of a licensed medicine was amended (page 84, Appendix 7):

'Currently, the licensing arrangements for the different BoNT-A products are quite narrow and limit injection within the terms of the licence to certain muscles in the arm and/or leg. See Section 6.3 for the licensing arrangements in place at the time of guideline publication for the different products. To check current product licensing please visit www.medicines.org.uk.'