1000 Section - Early post stroke spasticity: How soon could we treat it with botulinum toxin?

Case Diagnosis: An early spasticity development after an haemorrhagic stroke impacts on subacute rehabilitation outcomes. Its multimodal approach, including botulinum toxin, hasn't been encouraged.

Case Description:

                                                                    

A 38-year-old working man, developed a sudden left hemiparesis due to frontoparietal intracerebral haemorrhagic cavernoma, in May 2025. He was transferred to a public rehabilitation unit a week after neurosurgery stabilisation. 
Two weeks later, spasticity was developed. Oral baclofen was started, no changes obtained.
His physical examination described unstable seating, unable to autonomous transferences, severe upper limb paresis, lower limb co-contraction when standing. A multilevel spasticity (MAS 2-3 and Tardieu Modified 2-3) was registered.
The patient goal was to be able to move his arm and walk.
An ultrasound-guided multilevel abobotulinumtoxin-A (600 UI) injection at elbow flexor, wrist flexor, finger flexor, hip adductor and knee flexor muscles was performed, keeping multimodal intensive rehabilitation.
Three weeks post injection, changes in hypertonia (MAS 1, MTS 1) allowed him to seat and stand, walk with a cane, and dress. A GAS 0 was scored. He was discharged, with outpatient rehabilitation process prescribed.

Discussions: An early multimodal spasticity treatment, considering botulinum toxin injection, is able to improve function. This case, to our knowledge, is one of the earliest described. This modality, considering focal management with eco-guided botulinum toxin A, was observed to be safe and effective to achieve rehabilitation goals in a subacute rehabilitation setting.
It's important to highlight network in a public health system is possible to achieve when needed.
Abobotulinumtoxin-A, in this case, was prescribed for administrative issues, considering is the neurotoxin available at this public health institution.

Conclusions: An early spasticity multimodal treatment is encouraged to be started to obtain functionality outcomes, considering focal management with botulinum toxin A.