A group of doctors from around the world, who are experts in treating muscle stiffness and spasm (also called spasticity), reviewed the current scientific evidence supporting the effectiveness of using botulinum toxin injections in treatment of spasticity that results from a stroke. When evidence is not available, they discussed and agreed on the best way to treat spasticity using botulinum toxin. The recommendations made by these expert doctors can be used by less-experienced doctors as a guide to how best to use botulinum toxin injection in treating spasticity after a stroke. This consensus paper is derived from a meeting of an international group of 19 neurological rehabil itation specialists with a combined experience of more than 250 years (range 4-25 years; mean 14.1 years) in treating poststroke spasticity with bot ulinum toxin A. The group undertook critical assess ments of some recurring practical challenges, not yet addressed in guidelines, through an exten sive literature search. They then discussed the results in the light of their individual clinical experience and developed consensus statements to present to the wider community who treat such patients. The analy sis provides a comprehensive overview of treatment with botulinum toxin A, including the use of adjunctive therapies, within a multidisciplinary con text, and is aimed at practicing clinicians who treat patients with poststroke spasticity and require further practical guidance on the use of botulinum toxin A. This paper does not replicate information published elsewhere, but instead aims to provide practical advice to help optimize the use of botulinum toxin A and maximize clinical outcomes. The recom mendations for each topic are summarized in a se ries of statements. Where published highquality evidence exists, the recommendations reflect this. However, where evidence is not yet conclusive, the group members issued statements and, in some cas es, made recommendations based on their clinical experience.
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