# Botulinum toxin A for post-stroke spasticity: Insights from the French National Hospital Discharge Database (2015–2023)

## TL;DR

This study analyzed botulinum toxin A use for post-stroke spasticity in France from 2015 to 2023, finding it remains underutilized despite its established benefits.

## Contribution

The study provides real-world insights into BoNT-A treatment trends and disparities in post-stroke spasticity management in France.

## Key findings

- BoNT-A treatment rates for post-stroke spasticity in France ranged from 1.4% in 2015 to 1.9% in 2022.
- Patients in specialized neurovascular or neurorehabilitation units were more likely to receive BoNT-A treatment than those in non-specialized units.
- The median time from stroke onset to the first BoNT-A injection was 258 days.

## Abstract

Botulinum neurotoxin type A (BoNT-A) is a well-established treatment for post-stroke spasticity. However, its real-world use remains underexplored. This study evaluated BoNT-A use trends among stroke survivors in France from 2015 to 2023.

A retrospective cohort study was conducted using data from the French National Hospital Discharge Database. We analyzed stroke hospitalizations and BoNT-A treatment rates by age and care pathway. Among patients presenting with stroke between 2017 and 2019 who survived beyond 6 months post-stroke, we estimated the prevalence of patients with coded post-stroke spasticity, BoNT-A use, and time from stroke onset to spasticity coding and the first BoNT-A injection.

Between 2015 and 2023, 1,170,436 hospitalizations for stroke were recorded in France. BoNT-A treatment rates remained low, ranging from 1.4% in 2015 to 1.9% in 2022. BoNT-A treatment rates increased from 3.3% to 3.8% in stroke survivors aged 20–29 and from 1.0% to 1.6% in those aged 70–79 between 2015 and 2022. Patients who, during their care pathway, stayed in a neurovascular or neurorehabilitation unit were more likely to receive BoNT-A treatment—rising from 2.0% in 2015 to 2.6% in 2022 and 7.3% to 9.6%, respectively—than those managed in non-specialized units, where rates increased from 0.9% in 2015 to 1.1% in 2022. Among 287,370 patients presenting with stroke between 2017 and 2019, 37,692 (13.1%) were coded with post-stroke spasticity, 8056 (2.8%) received ⩾1 BoNT-A injection between 2017 and 2023, 4360 (1.5%) received ⩾3 injections, and 1003 (0.35%) received ⩾3 injections spaced ⩽6 months apart. The median time from stroke onset to spasticity coding was 96 days, and to the first BoNT-A injection 258 days.

BoNT-A remains underutilized in the treatment of post-stroke spasticity in France. These results emphasize the need to enhance access to and adherence to BoNT-A therapy to optimize post-stroke spasticity management.

Graphical abstract