Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity?

(en) OBJECTIVE: To discuss the effectiveness, indications, limitations and side effects of botulinum toxin type A and selective neurotomy for treating focal spastic muscle overactivity to help clinicians choose the most appropriate treatment. METHODS: Expert opinion based on scientific evidence and personal experience. RESULTS: Botulinum toxin type A can decrease muscle tone in different types of spastic muscle overactivity, which allows for treating a large variety of spastic patterns with several etiologies. The toxin effect is sometimes insufficient to improve functional outcome and is transient, thereby requiring repeated injections. Selective neurotomy is a permanent surgical treatment of the reflex component of the spastic muscle overactivity (spasticity) that is effective for spastic equinovarus foot. The neurotomy provides a greater and more constant reduction in spasticity. However, the long-lasting effect on the non-reflex muscle overactivity, especially dystonia, is doubted. The effectiveness, clinical indications, advantages, side effects and limitations of both techniques are discussed. CONCLUSION: Botulinum toxin type A has the highest level of evidence and the largest range of indications. However, the botulinum toxin effect is reversible and seems less effective, which supports a permanent surgical treatment such as selective neurotomy, especially for the spastic foot. Further research is needed to compare the effect of botulinum toxin type A and selective neurotomy for the different types of spastic muscle overactivity and clinical patterns.

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Deltombe, T., Lejeune, T., & Gustin, T. (2019). Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity? Annals of Physical and Rehabilitation Medicine, 62(4), 220-224. https://doi.org/10.1016/j.rehab.2018.07.008 (Original work published 2019)