Pooled systematic studies that compare treatment stragegies for post-stroke spasticity prove that Botulinum toxin-A (BoNT-A) has superior efficacy and safety and has become the first line management in tandem with physiotherapy. The natural evolution of spasticity show that, not only are neural mechanisms of muscle hypertonus come into play, but that biomechanical forces may likely set in 3 months after stroke. Uses of BoNT-A have been driven by pre-defined goals in the established stage of spasticity (i.E. > 6 months from onset of stroke), as well as the practice of repeat cycle injections to reduce muscle tone. About 19-33% of patients develop spasticity within 3 months after the ictus. Early intervention with BoNT-A (i.e. < 3 months from onser stroke spasticity) can be aimed at preventing the increasing severity of spasticity and the contracture development. There are two randomiaed double blind placebo-controlled trials, and a one single blind comparator trial with a non-injected group, that have recently been performed as early BoNT-A intervention, in tandem with rehabilitation. All the 3 trials showed benefit in terms of reduction in muscle tone with BoNT-A, and one study showed improvement in function, in subanalysis of severely weak muscles at baseline. In the large double blind placebo controlled study, pain reduction was achieved and muscle tone had sustained reduction over the longitudinal observation of 24 weeks, despite a single cycle injection of BoNT-A. The combination of early nrurorehabilitation and early BoNT-A application is an appealing therapeutic approach for upper limb post-stroke spasticity. Neurorehabilitation by constraint-induced movement therapy, in tandem with BoNT-A have been proven to reduce muscle overactivity and improve motor control, but remains to be established in a setting of early spasticity.

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This is a rare case of a Filipina with "Bellydancer's Dystonia". She presented with persistent involuntary, writing contractions of the abdominal wall, absent during sleep. Patient had a history of a fall two years prior to consult. MRI or the whole spine showed a T6 and T8 compression fracture. The potential role of trauma in dystonia was thus, enunciated. Patient was then treated with Botulinum toxin A into the hyperactive muscles of the abdominal wall. A month after the intervention there was a significant decrease in the abdominal contractions.

Human ; Botulinum Toxins, Type A ; Abdominal Wall ; Dystonia