BACKGROUND AND PURPOSE: The main aim of the study was to document the occurrence and evolution of post-stroke spasticity (PSS). The secondary goal was to identify predictors for increases and decreases in PSS rates during 12 months of subsequent follow-up. METHODS: In a longitudinal, multicenter, prospective cohort study, assessments were done at 7 days (V1), 6 months (V2), and 12 months (V3) after stroke onset. A total of 307 consecutive patients from four comprehensive stroke centers with the first-ever stroke of carotid origin and the presence of motor deficit at day 7 were included. The demographic data, baseline characteristics, Barthel index, degree and pattern of paresis and muscle tone were evaluated and recorded. Spasticity was assessed using the modified Ashworth scale. RESULTS: Spasticity was present in 45.0% of patients at V1, in 49.5% at V2, and in 43.2% at V3. A significant number of patients experienced changes in spasticity between visits: increased/new occurrence of spasticity in 32.5% (V1 and V2) and in 13.6% (V2 and V3) of patients; decreased occurrence/disappearance of spasticity in 18.5% (V1 and V2) and in 18.3% (V2 and V3) of patients. The number of patients with severe spasticity increased throughout the year, from 2.6% to 13.0% (V2) and 12.5% (V3). CONCLUSIONS: Spasticity developed in almost half of the included patients. The degree of spasticity often changed over time, in both directions. The rate of severe spasticity increased during the first year, with the maximum at 6 months following stroke onset.

1st Faculty of Medicine Department of Neurology and Center of Clinical Neuroscience Charles University Prague Prague Czech Republic

Department of Neurology School of Medicine University of Minnesota Minneapolis MN USA

Department of Rehabilitation Medicine Central Military Hospital Prague Czech Republic

Faculty of Medicine Department of Neurology Masaryk University and St Anne's Teaching Hospital Brno Czech Republic

Faculty of Medicine Department of Neurology Palacky University and University Hospital Olomouc Czech Republic

Faculty of Medicine Institute of Biostatistics and Analyses Masaryk University Brno Czech Republic

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The Central Effects of Botulinum Toxin in Dystonia and Spasticity