Botulinum Toxin Application in Post-Stroke Rehabilitation

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: 28 November 2026 | Viewed by 719

Special Issue Editors


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Guest Editor
Unit of Neurorehabilitation, University Hospital of Pisa, 56124  Pisa, Italy
Interests: rehabilitation; stroke; movement disorders; spasticity; dystonia; muscle modifications; resistance training; muscle function; gait analysis; robotic rehabilitation

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Guest Editor
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy
Interests: high technology neurorehabilitation; neurophysiology; biomechanics; stroke; spasticity; neuroplasticity

Special Issue Information

Dear Colleagues,

Botulinum toxin has become a cornerstone in the management of post-stroke spasticity, offering substantial benefits in reducing muscle overactivity, alleviating pain, improving motor control, and facilitating functional recovery. Its therapeutic potential extends beyond symptom relief, enabling patients to better engage in rehabilitation programs and improve their quality of life. Despite its widespread clinical application, many aspects of its use continue to evolve. Current research invetigates optimal dosing strategies, advanced injection techniques, individualized patient selection criteria, and effective integration with multidisciplinary rehabilitation approaches, including physiotherapy, occupational therapy, and emerging neurorehabilitation technologies.

This Special Issue, “Botulinum Toxin Application in Post-Stroke Rehabilitation,” aims to bring together the latest scientific findings and clinical innovations in this field. We welcome contributions spanning basic science, translational research, randomized controlled trials, case series, and expert reviews. Topics of interest include novel therapeutic protocols, outcome assessment tools, long-term efficacy, safety considerations, and cost-effectiveness analyses.

By fostering dialogue among clinicians, researchers, and rehabilitation specialists, this Special Issue seeks to provide a comprehensive and up-to-date overview of botulinum toxin applications in post-stroke care, with the ultimate goal of advancing evidence-based practice and improving patient outcomes worldwide.

Dr. Stefania Dalise
Dr. Carmelo Chisari
Guest Editors

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Keywords

  • botulinum toxin
  • post-stroke rehabilitation
  • spasticity
  • neurorehabilitation
  • injection techniques
  • motor recovery
  • functional outcomes
  • patient selection
  • clinical practice

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Published Papers (1 paper)

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Review

11 pages, 744 KB  
Review
Muscle-Specific Dosing of OnabotulinumtoxinA in Post-Stroke Upper-Limb Spasticity: A Descriptive Literature Review
by Małgorzata Cisowska-Adamiak, Magdalena Mackiewicz-Milewska and Elżbieta Dorota Miller
Toxins 2026, 18(4), 192; https://doi.org/10.3390/toxins18040192 - 21 Apr 2026
Viewed by 399
Abstract
Background: Botulinum neurotoxin type A is widely used in the management of post-stroke upper-limb spasticity; however, many studies report total injected doses rather than muscle-specific dosing, limiting clinical applicability. This study aimed to evaluate how frequently muscle-level dosing protocols of onabotulinumtoxinA are reported [...] Read more.
Background: Botulinum neurotoxin type A is widely used in the management of post-stroke upper-limb spasticity; however, many studies report total injected doses rather than muscle-specific dosing, limiting clinical applicability. This study aimed to evaluate how frequently muscle-level dosing protocols of onabotulinumtoxinA are reported and to assess consistency of dosing patterns across published studies. Methods: A literature search was conducted in PubMed, Wiley/Cochrane Library, and EBSCO/CINAHL using a structured search strategy informed by PRISMA guidelines. Studies published within the last 10 years reporting on onabotulinumtoxinA treatment in post-stroke upper-limb spasticity with muscle-specific dosing data were included. Studies not providing muscle-level dosing or not allowing extraction of post-stroke upper-limb data were excluded. Data were summarized descriptively and compared across studies. Results: Twenty-seven full-text articles were assessed, and five studies met the inclusion criteria. Muscle-specific dosing was consistently reported for commonly treated muscles such as biceps brachii and wrist and finger flexors, whereas other muscles were less frequently targeted. Variability in dosing between studies was observed, particularly in multicenter real-world datasets. Standardized high-dose protocols contrasted with individualized dosing strategies, which generally showed more moderate dose ranges. Expert recommendations often suggest higher doses than those observed in routine clinical practice. Conclusions: Muscle-specific dosing of onabotulinumtoxinA in post-stroke upper-limb spasticity is reported infrequently, and substantial variability exists between studies and clinical practice. Standardized reporting of muscle-level dosing and its relationship to baseline spasticity severity is needed to improve clinical applicability and reproducibility. Full article
(This article belongs to the Special Issue Botulinum Toxin Application in Post-Stroke Rehabilitation)
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