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New National Guidelines published for managing spasticity in adults

New guidance has been published on the management of spasticity, a condition with affects an estimated 12 million people worldwide, describing the effectiveness of botulinum toxin as a treatment.

Spasticity is involuntary muscle activity, which commonly follows damage to the central nervous system (brain and spinal cord). The damage causes a change in the balance of signals between the nervous system and the muscles and presents in a variety of ways. Harmful and distressing secondary effects include pain, deformity and impaired function. Spasticity management is challenging due to the diversity of symptoms and the differing goals or aims of treatment. It normally includes a combination of physical and pharmacological management, often using a variety of different approaches according to the individual patient’s needs.

Dr Stephen Ashford, a NIHR Clinical Lecturer and Consultant Physiotherapist at the Cicely Saunders Institute and the Editor of the new guidelines, explained the significance of the proposed use of BoNT as a treatment option: "These guidelines provide recommendations for the treatment of adults with spasticity with botulinum toxin (BoNT) as part of an overall patient management programme. Key goal areas identified for intervention are: pain relief, reduction of involuntary movements (e.g. 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) and mobility."

Local intramuscular injection of botulinum toxin (BoNT) is an established, well-tolerated treatment in the pharmacological management of spasticity. There is a strong body of evidence for its effectiveness in the management of both upper and lower limb spasticity. The new national guidelines provide an update to the document originally published in 2009 and in further developing the guidance included in that document, they help to progress treatment options for this condition.

The selection of appropriate patients likely to respond and the definition of clear, achievable, realistic and measurable goals are crucial to the successful use of BoNT in spasticity management. Although further research into new interventions is needed, if used according to the guidance, BoNT has the potential to reduce the overall costs of ongoing care in people with severe spasticity through the prevention of contracture and deformity, and improved ease of care and handling.

For more information about these recommendations, please see The Royal College of Physicians website for a downloadable copy of the guidelines.