Medical Necessity of Botox Injections for Spastic Hemiplegia

Clinical Rationale for Increased Dosage

• The American Heart Association recommends botulinum toxin injection to reduce severe hypertonicity in hemiplegic muscles, with Class IIa, Level A evidence 2
• Botox injections of 600 units every 12 weeks are medically necessary for a patient with spastic hemiparesis who has demonstrated inadequate response to smaller doses and requires higher dosing to control spasticity, improve function, and maintain safety with activities of daily living and mobility 1

Dosing Considerations

• The American Academy of Neurology suggests that botulinum toxin injection is useful to reduce severe hypertonicity in hemiplegic muscles, and the requested dose of 600 units every 12 weeks is clinically appropriate given the focal nature of the patient's increased tone, poor response to oral medications, and previous good response to botulinum toxin injections 1

Evidence Supporting Efficacy

• The American Heart Association considers botulinum toxin the treatment of choice for focal spasticity, and it has been shown to improve function, reduce pain, and improve quality of life 1, 2
• Botulinum toxin injections may decrease shoulder spasticity and pain associated with spasticity-related joint mobility restrictions, according to the American Heart Association 2