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Post-Stroke Spasticity – Botulinum Toxin — SCE Neurology MCQ

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ModerateNeurorehabilitationPost-Stroke Spasticity – Botulinum ToxinSCE Neurology

A 70-year-old man with a known right MCA territory stroke 3 months ago presents for rehabilitation review. He has a spastic left hemiplegia with a flexed posture of the left elbow and wrist. The spasticity is functionally limiting, preventing positioning for hygiene and dressing. Oral baclofen and tizanidine have provided insufficient relief. What is the most appropriate next step for the focal upper limb spasticity?

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Correct answer: C — Targeted botulinum toxin injections to selected upper-limb flexor muscles with therapy follow-up

For function-limiting focal upper-limb post-stroke spasticity that has not responded to oral treatment, targeted botulinum toxin combined with therapy is preferred. Intrathecal baclofen is generally reserved for more diffuse severe spasticity; surgery is considered for fixed contracture after conservative measures.

Reference: Royal College of Physicians, National Clinical Guideline for Stroke (2023): https://www.rcp.ac.uk/resources/national-clinical-guideline-for-stroke-2023/