400 Section - From Assessment to Reinjection: Mapping Five-Year Pathways and Clinical Effectiveness of Botulinum Toxin in a Moroccan Rehabilitation Center

To characterize five-year care trajectories of Moroccan patients evaluated as candidates for botulinum toxin, and to quantify injection rates, reevaluation, reinjection, loss to follow-up, and real-world clinical effectiveness using Modified Ashworth Scale (MAS) improvement.

Design:

A retrospective cohort study conducted at the Department of Physical Medicine and Rehabilitation, CHU Ibn Rochd, Casablanca (2020–2025). All patients considered eligible for botulinum toxin after standardized pre-toxin assessment were included. Reevaluation after the first injection was used to determine adherence; absence of reevaluation was attributed to loss to follow-up. Reinjection was defined as receiving ≥2 injections. MAS improvement was defined as a reduction of ≥1 grade in injected muscles. Demographic, etiological, and MAS data were analyzed with attention to the Moroccan rehabilitation context.

Results: The cohort comprised 220 patients (mean age 33.4 years; 50.5% women). Age distribution varied significantly across etiologies, ranging from 50.9 years in stroke to 10.6 years in cerebral palsy. Seventy patients (31.8%) did not receive an injection, and 35.7% of them were lost to follow-up. Among injected patients, reevaluation rates were 54.0% in stroke (27/50), 50.0% in multiple sclerosis (6/12), 48.5% in spinal cord injury (16/33), 33.3% in traumatic brain injury (4/12), and 40.4% in cerebral palsy (19/47). Reinjection rates remained modest across etiologies (15.4%–21.4%). MAS analysis included 621 injected muscles: 302 (48.6%) improved and 94 (15.1%) remained unchanged. Cerebral palsy showed strong responsiveness, particularly in triceps surae and adductors.

Conclusion:

This five-year Moroccan cohort highlights heterogeneous progression across the botulinum toxin pathway, with substantial loss to follow-up both before and after the first injection. Despite these discontinuities, nearly half of injected muscles demonstrated objective MAS improvement, confirming meaningful clinical effectiveness. Strengthening structured follow-up strategies is essential to preserve therapeutic benefit and enhance long-term outcomes in resource-constrained rehabilitation systems.