[Clinical practice guidelines for the treatment of spasticity with botulinum toxin].

INTRODUCTION: Spasticity is an important medical and social problem with a high rate of incidence both in childhood, where it is mainly a result of infantile cerebral palsy, and in adults, where it is frequently brought about by a cerebrovascular accident, traumatic brain injury, spinal cord injury or multiple sclerosis, among other pathologies. It gives rise to important problems that have a significant effect on the quality of life of patients and their caregivers. Clinical practice guidelines (CPG) are instruments that help professionals, administrators and planners to make decisions that can improve clinical outcomes. DEVELOPMENT: Due to the complexity of spasticity, its evaluation and treatment should be carried out by specialised units using a multidisciplinary approach. One of the first-line treatment options is botulinum toxin type A (BTA). For this treatment to be successful and to be able to evaluate the patient's progress, it is advisable to have a work protocol that includes the knowledge and tools necessary to use BTA in the most suitable way and in agreement with the available scientific evidence. All these factors led the Spasticity Unit to consider the need to draw up a set of CPG.
CONCLUSIONS: These CPG have been in use at the Hospital Universitari Mutua de Terrassa for 15 years, and are updated on a regular basis. This has enabled us to carry out a standardised selection of spastic patients and to establish a clear-cut set of treatment goals. It has also allowed us to implement a suitable plan regarding follow-up, the adjuvant therapies needed for each of the patients and an evaluation of results that is as objective as possible.