Friday, 28 October 2016

Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force

2016 Oct 27. [Epub ahead of print]

Author information

  • 1Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
  • 2Chulalongkorn Centre for Excellence on Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
  • 3Department of Neurology, King Faisal Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
  • 4Basic and Clinical Neurosciences Research Laboratory, University Medical School of Marrakech, Marrakech, Morocco.
  • 5University of Sao Paulo, Sao Paulo, Brazil.
  • 6Department of Neurology, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht, Germany.
  • 7Department of Adult Neuro-Rehabilitation, Adult Botulinum Toxin Clinics, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal.
  • 8Department of Neurology, University of Tokushima, Tokushima, Japan.
  • 9Centre de Rééducation et Medicine Physique, Hôpital du Jura, Porrentruy, Switzerland.
  • 10Department of Neurology, Palacky University, Olomouc, Czech Republic.
  • 11Department of Neurology, Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina.
  • 12Clinic 'Cecil Plus', Moscow, Russia.
  • 13Department of Neurology, Bonn University, Bonn, Germany.
  • 14Department of Neurology, Ljubljana University Medical Centre, Ljubljana, Slovenia.
  • 15Department of Neurology, University of Zagreb, Zagreb, Croatia.
  • 16Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines.
  • 17Department of Neurology, Universidad de Monterrey, Monterrey, Mexico.
  • 18Department of Neurology, Maternus-Klinik für Rehabilitation, Bad Oeynhausen, Germany.
  • 19Department of Neurology, Movement Disorders Clinic, Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
  • 20Scientific Research Institute of Neurology, Moscow, Russia.
  • 21Department of Neurology, Rostock University, Rostock, Germany.
  • 22IAB-Interdisciplinary Working Group for Movement Disorders, Hamburg, Germany.


Botulinum toxin (BT) therapy is an established treatment of spasticity due to stroke. For multiple sclerosis (MS) spasticity this is not the case. IAB-Interdisciplinary Working Group for Movement Disorders formed a task force to explore the use of BT therapy for treatment of MS spasticity. A formalised PubMed literature search produced 55 publications (3 randomised controlled trials, 3 interventional studies, 11 observational studies, 2 case studies, 35 reviews, 1 guideline) all unanimously favouring the use of BT therapy for MS spasticity. There is no reason to believe that BT should be less effective and safe in MS spasticity than it is in stroke spasticity. Recommendations include an update of the current prevalence of MS spasticity and its clinical features according to classifications used in movement disorders. Immunological data on MS patients already treated should be analysed with respect to frequencies of MS relapses and BT antibody formation. Registration authorities should expand registration of BT therapy for spasticity regardless of its aetiology. MS specialists should consider BT therapy for symptomatic treatment of spasticity.


Botulinum toxin; IAB-Interdisciplinary Working Group for Movement Disorders; Multiple sclerosis; Recommendations; Review; Spasticity; Therapeutic use