BoNT-A Treatment Continuity and Patient- or Caregiver-Reported Reasons for Discontinuation or Irregular Continuation in Post-Stroke Spasticity: A Retrospective Cohort Study

Abstract

Objective This study aimed to evaluate botulinum neurotoxin type A (BoNT-A) treatment continuity in patients with post-stroke spasticity, to identify patient- or caregiver- reported reasons for treatment discontinuation or irregular continuation, and to examine the associations between available demographic/clinical variables and the number of injections. Material and Methods In this retrospective cohort study, medical records of patients who received at least one botulinum toxin injection for post-stroke spasticity between 2012 and 2024 were reviewed. A total of 81 patients included in the final analysis responded to questions regarding reasons for not maintaining regular BoNT-A treatment. Results A total of 157 injections were administered over the 12-year study period. The mean number of injections was 1.9 (range: 1–7), and the mean interval between consecutive injections was 13.3 months. Forty-seven patients (58%) received only one injection session. Reasons for treatment discontinuation or irregular continuation were analyzed among 74 patients after excluding 7 patients who continued treatment at another center. The most frequently reported reason was lack of awareness regarding the need for repeated BoNT-A injections (54.1%). Other reasons included perceived lack of benefit from the injection (24.3%), reduction in spasticity (10.8%), comorbidities or other health problems limiting follow-up (6.8%), fear of injections (4.1%), inability to take time off work (1.4%), and misconception regarding reimbursement coverage (1.4%). Conclusion BoNT-A treatment continuity was low among patients with post-stroke spasticity. The most frequently reported reason for treatment discontinuation or irregular continuation was patient- or caregiver-reported lack of awareness regarding the need for repeated treatment. These findings suggest that clearer and standardized patient/caregiver education, together with regular follow- up systems, may support treatment continuity in BoNT-A therapy.

Keywords

• Botulinum toxin type A
• Post-stroke spasticity
• Treatment adherence
• Treatment discontinuation
• Patient education

Supporting Institution

No funding source influenced the preparation or conduct of this study, the preparation of the manuscript, or the decision to submit it for publication.

Ethical Statement

This study was approved by the Süleyman Demirel University Ethics Committee for Health Sciences (12.05.2025, approval no: 96/37). The research was conducted in accordance with the ethical principles of the Declaration of Helsinki.

Thanks

We thank all patient participants who contributed to the conduct of this study.

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