BoNT-A Treatment Continuity and Patient- or Caregiver-Reported Reasons for Discontinuation or Irregular Continuation in Post-Stroke Spasticity: A Retrospective Cohort Study

ObjectiveThis study aimed to evaluate botulinum neurotoxintype A (BoNT-A) treatment continuity in patients withpost-stroke spasticity, to identify patient- or caregiver-reported reasons for treatment discontinuation or irregularcontinuation, and to examine the associationsbetween available demographic/clinical variables andthe number of injections.Material and MethodsIn this retrospective cohort study, medical records ofpatients who received at least one botulinum toxininjection for post-stroke spasticity between 2012 and2024 were reviewed. A total of 81 patients included inthe final analysis responded to questions regardingreasons for not maintaining regular BoNT-A treatment.ResultsA total of 157 injections were administered over the12-year study period. The mean number of injectionswas 1.9 (range: 1–7), and the mean interval betweenconsecutive injections was 13.3 months. Forty-sevenpatients (58%) received only one injection session.Reasons for treatment discontinuation or irregularcontinuation were analyzed among 74 patients afterexcluding 7 patients who continued treatment at anothercenter. The most frequently reported reason waslack of awareness regarding the need for repeatedBoNT-A injections (54.1%). Other reasons includedperceived lack of benefit from the injection (24.3%),reduction in spasticity (10.8%), comorbidities or otherhealth problems limiting follow-up (6.8%), fear of injections(4.1%), inability to take time off work (1.4%), andmisconception regarding reimbursement coverage(1.4%).ConclusionBoNT-A treatment continuity was low among patientswith post-stroke spasticity. The most frequently reportedreason for treatment discontinuation or irregularcontinuation was patient- or caregiver-reported lack ofawareness regarding the need for repeated treatment.These findings suggest that clearer and standardizedpatient/caregiver education, together with regular follow-up systems, may support treatment continuity inBoNT-A therapy.