Spasticity in adults: management using botulinum toxin: national guidelines


Guidelines currently under review

Local intramuascular injection of botulinum toxin (BT) is an established treatment for spasticity, with strong evidence for its efficacy. The purpose of these guidelines is to provide clinicians with the knowledge and tools to use BT effectively. The keys to successful intervention are appropriate patient selection, establishment of clear goals for treatment and appropriate follow-up therapy.

These guidelines provide clear recommendations on:

  • coordinated spasticity management
  • patient selection
  • prescribing, supply and administration of BT by non-medical practitioners
  • follow-up and outcome evaluation

Tools to aid clinicians include a comprehensive and detailed list of injection sites together with appropriate dosages at each site, and several methods of assessing spasticity and outcome of treatment.

If used according to the guidance, BT can improve the lives of those suffering from spasticity and of those caring for them, as well as reducing the overall costs of ongoing care. The guidance is essential reading for all clinicians dealing with stroke patients, people with multiple sclerosis and patients with severe traumatic brain injury.

The guidelines can be purchased or downloaded as a pdf.


  • The guidance development process
  • Spasticity - what is it and why does it matter?
  • Botulinum in clinical practice
  • Management and treatment of spasticity
  • Using botulinum toxin to treat spasticity
  • Formal evaluation of effectiveness
  • Prescribing, supplying and administration by non-medical injectors
  • Organisation of services
  • Appendix 1 Evidence for the effectiveness of botulinum toxin
  • Appendix 2 Injection sites for botulinum toxin
  • Appendix 3 Tools to assess outcome
  • Appendix 4 Goal Attainment Scaling - how to do it
  • Appendix 5 Dataset and proforma (example)
  • Appendix 6 Botulinum toxin advice sheet
  • Appendix 7 Methods for prescribing, supply and administration of botulinum toxin by non-medical injectors
  • Appendix 8 Patient organisations
  • Appendix 9 Conflicts of interest

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