Tailoring BoNT A treatment and assessment across recovery stages after stroke: a report of four clinical cases

Achieving effective spasticity management in post-stroke patients remains a significant therapeutic challenge. It requires the anticipation and management of multiple potential complications through a complex, individualized therapeutic approach. The therapeutic goals in stroke-related spasticity vary considerably depending on the intensity and duration of spasticity, as well as the degree of motor control in the affected limb segments. This study presents four clinical case reports involving patients with post-stroke spasticity ranging from grade 1+ to 4 on the Modified Ashworth Scale (MAS), each exhibiting a distinct temporal profile of symptom progression and levels of motor control in affected limbs. All patients received conservative rehabilitation therapy in conjunction with botulinum toxin (BoNT-A) administration. Spasticity assessment is essential for evaluating treatment efficacy and for planning and refining rehabilitation strategies. Employing case-appropriate functional clinical scales facilitates dynamic assessment and quantification of motor deficits, thereby enabling precise definition and ongoing monitoring of therapeutic goals. Given the heterogeneous functional status of patients with post-stroke spasticity, therapeutic objectives and evaluation strategies must be tailored accordingly. BoNT-A therapy necessitates a patient-specific approach concerning dosing and injection intervals. Repeated BoNT-A treatment in cases of severe spasticity produced sustained reductions in limb pain and mitigated periarticular tissue damage. In patients with mild spasticity and preserved motor function, functionality reached substantial recovery, as reflected in outcomes from appropriately selected functional measures, with injections spaced at intervals exceeding three months and employing progressively lower doses.