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Case Reports
. 2025 Jul 1;25(1):263.
doi: 10.1186/s12883-025-04266-6.

Botulinum toxin type A for amyotrophic lateral sclerosis lower limb spasm: two case reports

Qiang Duan  1 , Chao Li  2 , Chunxia Wei  3 , Qian Wang  4 , Bo Wang  3 , Liangwen Sun  3 , Yongjing He  3 , Junxia Qin  3 , Xiaoqun Huang  5
Affiliations
Case Reports

Botulinum toxin type A for amyotrophic lateral sclerosis lower limb spasm: two case reports

Qiang Duan et al. BMC Neurol. .

Abstract

Background: Patients with amyotrophic lateral sclerosis (ALS) often experience spasticity, which can severely affect their ability to perform basic activities like standing and walking, potentially diminishing their already compromised quality of life. Botulinum toxin type A (BTX-A) is a first-line drug for spastic management. However, there are limited reports on its effectiveness in reducing muscle tone among ALS patients, with scarcely any related research conducted in China. We conducted the clinical observation and follow-up study through the relevant ethical post (ChiCTR2200061794). Clinical registration was on July 2, 2022. All participants provided written informed consent.

Case presentation: We report two cases of middle-aged male patients, both diagnosed with ALS, who presented with symptoms such as limb stiffness and walking limitation due to increased muscle tone in the lower limbs. Based on the spasticity of the patient's lower limbs, the corresponding target muscles were selected for BTX-A treatment under ultrasound guidance, and the patients were evaluated on relevant functional scales before injection (baseline, T0) and at three follow-up visits (T1: 2 weeks, T2: 4 weeks, T3: 8 weeks).

Conclusion: Appropriate BTX-A injected into the target muscles could effectively depress the spasticity of ALS patients without apparent side effects.

Keywords: ALS; BTX-A; Lower limb spasticity; UMN; Ultrasound.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Informed consents were obtained from the patients to publish those cases, and approval for this study was provided by the Research Ethics Committee of The First College of Clinical Medical Science. Consent for publication: Written informed consents were obtained from the patients to publish those two cases, including any potentially identifiable images or data in this article. Declaration of large language models: None of Large Language Models was used in manuscript writing. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Intramuscular injection localization techniques. Schematic diagram of the medial and lateral heads of the gastrocnemius and soleus at the point of injection (A). Somatic localisation of the medial and lateral heads of the gastrocnemius and soleus (B). Ultrasonographic localisation of the medial and lateral heads of the gastrocnemius and soleus (C)
Fig. 2
Fig. 2
Intramuscular injection localization techniques. Schematic diagram of the adductor longus and the adductor magnus at the point of injection (A). Somatic localization of the adductor longus and the adductor magnus (B). Ultrasonographic localization of the adductor longus and the adductor magnus (C)
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