Botulinum Neurotoxin Type A Injections Reduce Spasticit Mild to Moderate Hereditary Spastic Paraplegia— Report of 19 Cases Martin J. Hecht, MD, 1,2 * Henning Stolze, MD, 3,4 Matthias Auf dem Brinke, MD, 5 Ralf Giess, MD, 6 Thoams Treig, MD, 7,8 Martin Winterholler, MD, 9 and Jo¨rg Wissel, MD, 10 for the German Spasticity Education Group 1 Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany 2 Department of Neurology, BKH Kaufbeuren, Germany 3 Department of Neurology, University of Kiel, Kiel,Germany 4 Department of Neurology, Diako Hospital, Flensburg, Germany 5 Department of Neurological Rehabilitation, Bad Wildungen, Germany 6 Department of Neurology, Henriettenstiftung, Hannover, Germany 7 Neurological Rehabilitation Centre, Ernst-Moritz-Arndt University, Greifswald, Germany 8 Neurological Rehabilitation Centre, Schwarzwaldkliniken, Bad Krozingen, Germany 9 Department of Neurology, Rummelsberger Kliniken, Schwarzenbruck, Germany 10 Department of Neurological Rehabilitation, Beelitz Heilsta¨ tten, Beelitz, Germany Abstract: Hereditary spastic paraplegia (HSP) is characterized by lower extremity spasticity. Symptomatic therapy generally includes physical therapy and oral antispastic agents, in se- lected cases intrathecal baclofen. Because of the positive results in other treatments of spasticity, the use of botulinum neuro- toxin type A (BoNT-A) might also be considered for patients with HSP. We report the effect of BoNT-A injections in 19 unselected patients with HSP treated by the members of the German Spasticity Education Group. In 17 patients, the mod- ified Ashworth scale had improved by one point. In one patient, it improved by three points. Mostof the patients reported reduction of spasticity. BoNT-A injections were continued in 11 of 19 patients (57.9%). All of the patients with continued injections had a good or very good global subjective improve- ment. Patients with less pronounced spasticity and patients wi accompanying physical therapy tended to exhibit a better ef- fect.Only four patients reported adverse effects which were increased weakness in three patients and pain in one patient. BoNT-A injections appear to reduce spasticity effectively and safely,especially in patients with mild to moderate spasticity. The preliminary results of ourcase series should encourage larger studies of BoNT-A injections in HSP. © 2007 Movement Disorder Society Key words: hereditary spastic paraplegia; HSP;botulinum toxin A; spasticity; therapy. Hereditary spastic paraplegia (HSP) is characterized by lower extremity spasticity and muscle weakness. Spo- radic forms are also known. Symptoms may evolve at variousages,from childhood to advanced age and progress slowly. 1 Usually, spasticity is much more prom- inent than weakness. 1 Spasticity is often pronounced in hip flexors and adductors and plantar flexors of the foot. Gaitanalysis showed significantly lower gaitvelocity, stride length, step height, and range of motion ofthe knee angle. 2 Although upper extremity deep tendon re- flexes are often brisk, there is usually no sign of upper extremity weakness or spasticity. 1 Until now, there is no causal treatment. Symptomatic therapy to date primarily includes physical therapy and oralmedication for spasticity (e.g. baclofen, tizanidine, *Correspondence to: Dr. Martin J. Hecht, Department of Neurology, BKH Kaufbeuren, Am Kaiserweiher 8, D-87600 Kaufbeuren, Ger- many.E-mail: martin.hecht@bkh-kaufbeuren.de Received 27 June 2006; Revised 21 July 2007; Accepted 5 October 2007 Published online 12 November 2007 in Wiley InterScience (www. interscience.wiley.com). DOI: 10.1002/mds.21809 Movement Disorders Vol. 23,No.2,2008,pp.228 –233 © 2007 Movement Disorder Society 228