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Spasticity is characterized by increased muscle tone, which can result in pain, contractures, impaired hygiene, and deformities. Stroke is a leading cause of paresis, and nearly 40% of stroke patients will develop spasticity.

Objective: To assess trends in upper and lower extremity spasticity-reducing surgery and botulinum toxin A (BoNT-A) treatment.

Design: A national cohort register study.

Methods: Upper and lower extremity spasticity-reducing surgery and BoNT-A treatment in Swedish stroke patients over a 12-year period was assessed using the National Patient Register.

Results: A total of 6,258 patients were treated during this period; their mean age was 58, and the majority were male. In both upper and lower extremities, tenotomy was the most common surgical procedure, followed by tendon lengthening. The need for BoNT-A injections was significantly reduced after surgery compared with before surgery. The total number of BoNT-A treatments increased during the study period, and ultrasound guidance of injections became more common.

Conclusion: The frequency of BoNT-A treatments was significantly reduced in patients who underwent surgery. Even though no causative association can be established due to the nature of these registry data, this may indicate that surgery reduces the need for further BoNT-A treatments.