317 - Early Botulinum Toxin Intervention for Post-Stroke Spasticity: A Case Report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SY

Sera Yoo, MD

Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States

Co-Author(s)

SL

Schan Lartigue, MD

Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States
CM

Christina Mtanes, MD

Resident, PGY-1
Yale New Haven Hospital
New Haven, Connecticut, United States
JH

Jennifer Hankenson, DO

Assistant Professor of Orthopaedics & Rehabilitation
Yale New Haven Hospital
New Haven, Connecticut, United States

Submitter(s)

SY

Sera Yoo, MD

Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States

Case Diagnosis: A 69-year-old male developed right hemiparesis with upper extremity spasticity following an acute left basal ganglia infarct. Within three months of onset, he received botulinum neurotoxin type A (BoNT-A) injections targeting the right upper extremity.

Case Description: On initial presentation, he demonstrated limited range of movement of the wrist, fingers, and pronator teres. BoNT-A treatment was administered to the pronator teres, flexor carpi radialis/ulnaris, and flexor digitorum profundus. At follow-up, the patient reported improved independence in functional tasks, such as carrying groceries and showering. Gains in range of motion and reduction in tone were consistently maintained across injection cycles, with sustained outcomes for five years.

Discussions: Post-stroke spasticity (PSS) is a common sequela, affecting up to 40% of stroke survivors and contributing to pain, contracture, and functional impairment. Early identification and intervention are critical to prevent secondary complications and optimize rehabilitation outcomes. BoNT-A is the recommended first-line treatment for focal spasticity, with evidence supporting its safety and efficacy in both upper and lower limb involvement. PSS commonly develops within weeks to months; however, current evidence offers no clear consensus on early versus delayed BoNT-A treatment, given the limited studies that evaluate timing and improved function. In this case, BoNT-A was given three months after stroke onset, leading to preserved joint mobility, improved motor control, and enhanced participation in activities of daily living for approximately five years. Our findings favor the use of early administration because of the significant functional and long-term benefits in independence.

Conclusions: Early administration of BoNT-A for post-stroke spasticity is safe, effective, and prevents secondary complications such as contracture and pain. Integration with rehabilitation therapy is essential for optimal outcomes. Functional gains are most pronounced in passive mobility and self-care, with limited impact on skilled arm use. Early intervention should be considered in patients at risk for disabling spasticity following stroke.