Benefits and Risks of Botulinum Toxin-A Injections for Tone Management

Background Information: Botulinum Toxin-A (BoNT/A) is being used as an adjunct to therapy to reduce focal spasticity, increase range of motion (ROM), manage pain, improve function, and possibly delay surgical intervention (Hoare & Imms, 2004). BoNT/A inhibits acetylcholine release at the neuromuscular junction resulting in temporary denervation and decreased muscular activity. Reinnervation eventually restores muscle function. Adverse effects include excessive weakness and atrophy of injected muscle, unintended weakness in adjacent muscles, and immunoresistance to BoNT/A (Ghasemi, Salari, Khorvash, & Shaygannejad, 2013)