Botulinum neurotoxin A in the treatment of muscle spasticity: A review of new advances in mechanism, therapeutic strategies, and precision therapy

doi:10.13418/j.issn.1001-165x.2026.2.17

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Chinese Journal of Clinical Anatomy ›› 2026, Vol. 44 ›› Issue (2) : 234-238. DOI: 10.13418/j.issn.1001-165x.2026.2.17

Botulinum neurotoxin A in the treatment of muscle spasticity: A review of new advances in mechanism, therapeutic strategies, and precision therapy

Zhao Hongbo, Yang Shengbo*

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Abstract

Muscle spasticity, frequently occurring after stroke or spinal cord injury, severely compromises motor function and quality of life. Botulinum neurotoxin A, a targeted neuromuscular junction blocker, serves as a first line treatment for focal spasticity. Its classic mechanism involves cleaving synaptosomal-associated protein 25, thereby inhibiting acetylcholine release. Recent research has unveiled its multi-level central modulatory effects. BoNT-A exerts systemic therapeutic benefits by reducing muscle spindle sensitivity, restoring spinal inhibitory balance, disrupting the “pain-spasm cycle,” and driving functional reorganization in the cerebral cortex. Clinically, it has proven effective in significantly improving muscle tone, range of motion, and pain. Current treatment is advancing toward greater precision. The use of imaging and electrophysiological guidance has enhanced injection accuracy. Research on novel targets, such as the nerve entry point and Intramuscular nerve dense region, aims to achieve "enhanced efficacy with reduced dosage." Furthermore, multimodal approaches combining BoNT-A with rehabilitation or extracorporeal shockwave therapy demonstrate synergistic advantages. However, long-term safety profiles, particularly concerning muscle structure and immunogenicity, require continued scrutiny. Future directions should integrate artificial intelligence-based prediction models, novel BoNT formulations, and multimodal strategies to advance treatment toward a higher standard of personalization and functional restoration.

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Botulinum neurotoxin A / / / Muscle spasticity / / / Neuromuscular junction / / / Mechanism / / / Precision Therapy

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Zhao Hongbo, Yang Shengbo. Botulinum neurotoxin A in the treatment of muscle spasticity: A review of new advances in mechanism, therapeutic strategies, and precision therapy[J]. Chinese Journal of Clinical Anatomy. 2026, 44(2): 234-238 https://doi.org/10.13418/j.issn.1001-165x.2026.2.17

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