# TRENDS IN SPASTICITY-REDUCING SURGERY AND BOTULINUM TOXIN TREATMENT FOR POST-STROKE SPASTICITY: A REGISTER STUDY ON 6,258 PATIENTS IN SWEDEN, 2010–2021

## TL;DR

This study examines trends in spasticity treatments for stroke patients in Sweden from 2010 to 2021, finding that surgery may reduce the need for botulinum toxin injections.

## Contribution

The study provides real-world evidence on the effectiveness of spasticity-reducing surgery in decreasing botulinum toxin use.

## Key findings

- Tenotomy and tendon lengthening were the most common surgical procedures for spasticity.
- BoNT-A injection frequency decreased significantly after surgery.
- The total number of BoNT-A treatments increased over the 12-year study period.

## Abstract

Spasticity is characterized by increased muscle tone, which can result in pain, contractures, impaired hygiene, and deformities. Stroke is a leading cause of paresis, and nearly 40% of stroke patients will develop spasticity.

To assess trends in upper and lower extremity spasticity-reducing surgery and botulinum toxin A (BoNT-A) treatment.

A national cohort register study.

Upper and lower extremity spasticity-reducing surgery and BoNT-A treatment in Swedish stroke patients over a 12-year period was assessed using the National Patient Register.

A total of 6,258 patients were treated during this period; their mean age was 58, and the majority were male. In both upper and lower extremities, tenotomy was the most common surgical procedure, followed by tendon lengthening. The need for BoNT-A injections was significantly reduced after surgery compared with before surgery. The total number of BoNT-A treatments increased during the study period, and ultrasound guidance of injections became more common.

The frequency of BoNT-A treatments was significantly reduced in patients who underwent surgery. Even though no causative association can be established due to the nature of these registry data, this may indicate that surgery reduces the need for further BoNT-A treatments.

Stroke is a common cause for paresis. Many stroke patients develop spasticity with increased muscle tone resulting in pain, contractures, and deformities. Spasticity-related symptoms can be treated with stretching, splints, baclofen, botulinum toxin A (BoNT-A), and surgery. This study explores trends in BoNT-A treatment and spasticity-reducing surgery in the upper and lower extremities by using data from the National Patient Register in Sweden during a 12-year period. The findings indicate that a total of 6,258 patients were treated, the majority of whom were male; their mean age was 58. The 2 most common surgical procedures were tenotomy (sectioning of the tendon) and tendon lengthening. The frequency of BoNT-A injections was significantly reduced after surgery compared with before surgery. Although no causative association can be established due to the nature of this study, the findings may indicate that surgery reduces the need for further BoNT-A treatments.