Botulinum neurotoxin A (BoNTA) is rapidly gaining acceptance for management of spasticity secondary to spinal cord injury (SCI). Due to its increased usage, more undesirable effects and complications have come in light. Unwanted distant and/or generalised muscle weakness is possible following BoNTA administration in SCI population causing temporary neurological and functional decline. Physicians should carefuly perform a clinical assessment of every patient individually for risks stratification. Additional studies for adult population evaluating adverse-effects of high dose of BoNTA treatment for spasticity management are indicated.
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