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Neurological Rehabilitation

Retrospective Evaluation of the Impact of Early Versus Late Treatment With Botulinum Toxin A on Goal Attainment in Post-Stroke Spasticity

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Original Research Theater
Has Audio
Disclosure(s):
Alberto Esquenazi, MD: No relevant disclosure to display
Background and/or Objectives: Botulinum toxin A (BoNT-A) treatment initiation for post-stroke spasticity (PSS) is often delayed. This study evaluated the effect of BoNT-A treatment timing on clinical outcomes in patients with PSS.

Design: Pooled data from 5 studies. Eligible adults had ≥1 BoNT-A injection for PSS and goal attainment scaling (GAS) scores at baseline and 12 weeks. Stratification was based on prior BoNT-A use (BoNT-A-experienced, BoNT-A-naive) and time of BoNT-A initiation post-stroke (early [ < 1 year], late [≥1 year]). Primary objective: total GAS (GAS-T) score changes from baseline to 12 weeks. Secondary outcomes: proportions of patients with GAS-T score ≥50 at 12 weeks, changes in Modified Ashworth Scale (MAS) and quality-of-life (QoL) scores, safety.

Setting : Pooled analysis from clinical trials.

Participants : Adults with PSS

Interventions: BoNT-A

Main Outcome Measures: GAS scores, MAS, QoL scores

Results: Of 968 patients, 667 were BoNT-A-experienced (early, 48; late, 619) and 301 were BoNT-A-naive (early, 118; late, 183); 58.4% male, 38.0% aged ≥60 years, 81.9% upper limb spasticity only. Median time from stroke to BoNT-A treatment: 0.5 (early) versus 5.4 (late) years; mean (SD) baseline GAS scores were similar between BoNT-A-experienced (early, 36.7 [3.9]; late, 36.8 [3.6]) and BoNT-A-naive (early, 37.0 [3.4]; late, 36.9 [3.7]) cohorts. Mean (SD) change in GAS-T score from baseline to 12 weeks was significantly higher in the early versus late cohort for BoNT-A-naive (early, 16.2 [7.5]; late, 13.6 [9.0]; p=0.018), but not for BoNT-A-experienced (early, 14.1 [11.8]; late, 13.0 [8.9]; p=0.700). A significantly higher proportion of patients in the early versus late cohort had a GAS-T score ≥50 for BoNT-A-naive (early, 68.6%; late, 47.5%; p< 0.001) at 12 weeks, but not for BoNT-A-experienced (early, 52.1%; late, 47.3%; p=0.700). No significant between-cohort differences in MAS or QoL were observed; no new safety concerns identified.

Conclusions: Early versus late PSS treatment with BoNT-A may support better goal attainment, irrespective of prior BoNT-A treatment.