Botulinum Therapy for Spasticity in Israel

Post-stroke spasticity is one of the most common and disabling consequences of central nervous system injury. It manifests as pronounced muscle hypertonus, painful spasms, restricted joint mobility, impaired gait and arm function, and the formation of contractures. Spasticity is also seen in other neurological conditions, including multiple sclerosis (MS), traumatic brain injury, spinal cord injury, and other disorders.

In Israel, botulinum toxin therapy for spasticity is an established standard of care and is widely used in major public hospitals (for example, Shamir Medical Center (Assaf Harofeh) near Tel Aviv) as well as in specialized neurological clinics across the central region. Search queries such as “botulinum therapy for spasticity in Israel,” “treatment of post-stroke spasticity in Israel,” and “botulinum toxin spasticity Tel Aviv” frequently lead patients to this treatment method.

Why Spasticity Develops

Spasticity arises due to disruption of the corticospinal pathways and impairment of normal regulation of muscle tone. Muscles become overly active, resist stretching, form pathological synergies, and limit the functional capacity of the limbs.

After stroke, spasticity develops in approximately 25–45% of patients. In Multiple Sclerosis, spastic symptoms occur in 40–60% of patients and often lead to gait impairment and pain. Without adequate treatment and rehabilitation, spasticity leads to:

• formation of fixed contractures;
• significant pain and muscle spasms;
• gait and posture abnormalities;
• reduced independence in daily activities;
• increased caregiver burden.

Why Botulinum Therapy Is the Leading Treatment for Spasticity

Injections of Botulinum toxin type A are an internationally recognized method for treating focal and multifocal spasticity. In clinical guidelines on post-stroke spasticity management and spasticity in MS, botulinum therapy is a first-line option, especially when specific muscle groups are affected (hand, foot, elbow flexors, etc.).

Mechanism of Action of Botulinum Toxin

Botulinum toxin temporarily blocks acetylcholine release at the neuromuscular junction. This results in:

• reduced tone in overactive muscles;
• decreased spasms and pathological synergies;
• increased passive and active range of motion;
• reduction of pain and nighttime spasms;
• improved ability to perform physiotherapy and rehabilitation exercises.

The effect usually develops within 3–7 days after injections and lasts on average 3–4 months, after which the procedure may be repeated.

Indications for Botulinum Therapy in Spasticity

The strongest evidence base exists for post-stroke spasticity. Botulinum therapy is used in:

• spasticity of the hand and fingers (flexed wrist and fingers);
• upper limb flexor spasticity (elbow, shoulder);
• pronation-flexion posture of the forearm;
• adductor spasticity of the thigh;
• equinus deformity of the foot (“toe-walking” gait);
• spasticity of knee flexors and extensors.

In addition, botulinum toxin therapy is used for:

• spasticity associated with multiple sclerosis (MS-related spasticity);
• spasticity after traumatic brain injury or spinal cord injury;
• spastic syndromes in adult and pediatric cerebral palsy;
• localized spastic patterns interfering with movement or caregiving.

What Results Botulinum Therapy Provides

With an appropriately selected treatment plan, treatment of post-stroke spasticity with botulinum toxin allows for:

• reduced muscle tone and spasms;
• improved limb function (grip, weight-bearing, foot control);
• enhanced effectiveness of rehabilitation, physiotherapy, and occupational therapy;
• reduced pain and nighttime cramps;
• easier daily care (dressing, hygiene, positioning);
• reduced risk of contractures and deformities;
• improved gait and balance;
• greater independence and quality of life.

When combined with physiotherapy and exercise, the effect of botulinum therapy is significantly enhanced, which is reflected in all modern spasticity treatment guidelines.

How the Procedure Is Performed

Before the procedure, a neurological evaluation is required to assess spasticity severity, identify target muscles, and determine functional priorities. An individualized injection plan and dosing strategy are created.

• the procedure usually takes 15–30 minutes;
• injections are performed with a fine needle into pre-identified muscles;
• anatomical landmarks or additional navigation may be used;
• patients can resume normal activities immediately;
• physiotherapy is recommended the same or next day.

Limitations and Precautions

A weaker treatment effect may occur in cases of fixed contractures, severe generalized spasticity, or if rehabilitation is not performed in parallel. Side effects are usually mild: injection-site tenderness, small hematomas, or temporary weakness in the treated muscle.

Experience of Dr. Lidiia Prakhova

Dr. Lidiia Prakhova has more than 10 years of experience in treating spasticity and demyelinating CNS diseases. She works according to international protocols and uses certified botulinum toxin preparations: Botox®, Dysport®, and Xeomin®.

Search queries: botulinum toxin spasticity Israel, treatment of post-stroke spasticity Tel Aviv, botulinotherapy spasticity Israel.