{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T12:47:57Z","timestamp":1788526077816,"version":"build-2803163510"},"reference-count":66,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JRM"],"abstract":"<jats:p>Objective: The aim of this observational study was to describe the real-world use of botulinum toxin-A in patients with a stroke in the Netherlands.\nMethods: This study used longitudinal insurance claims data between 2012 and 2016 with 30% nationwide coverage and included patients with both stroke-related and botulinum toxin-A claims. All analyses were descriptive and displayed as summary statistics.\nResults: 60,222 patients with a stroke were identified, of whom 18,141 (30.1%) were treated in a rehabilitation centre or hospital and 1.7% (1,036 patients) were treated with botulinum toxin-A. A total of 2,855 botulinum toxin-A claims from 890 patients were included in the analysis (1.5% of all patients in the database). Mean age was 63.4 (SD\u2009\u00b1\u200914.0) years at index injection cycle, with a median follow-up of 3.7 years (interquartile range [IQR] 2.2\u20134.5 years). Patients received up to 16 injection cycles with a median of 2 injection cycles (IQR 1\u20135 cycles). The median Time-To-Next-Injection-Cycle was 17 weeks (IQR 13\u201325 weeks). The total number of injection cycles was 604 for abobotulinumtoxinA (22.1%) and 2,251 (78.8%) for onabotulinumtoxinA. Doses per cycle ranged from 200\u2013660 for abobotulinumtoxinA and 101\u2013400 units for onabotulinumtoxinA. \nDiscussion: Claims data from a national healthcare insurance fund in the Netherlands showed that only 1.7% of patients with post-stroke spasticity received botulinum toxin-A. Botulinum toxin-A treatment doses and intervals varied widely across patients and most patients received only 1 or 2 botulinum toxin-A injection cycles. Our results suggest undertreatment of spasticity with botulinum toxin-A and suboptimal treatment adherence in Dutch clinical practice.<\/jats:p>","DOI":"10.2340\/jrm.v58.43952","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T13:15:57Z","timestamp":1768482957000},"page":"jrm43952","source":"Crossref","is-referenced-by-count":3,"title":["Real-world use of botulinum toxin-A for post-stroke spasticity in the Netherlands: a retrospective claims study"],"prefix":"10.2340","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4647-9806","authenticated-orcid":false,"given":"Max","family":"Van Wijk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Verhoeven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thom S.","family":"Lysen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanne","family":"Van Ballegooijen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander C.H.","family":"Geurts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"138884","doi-asserted-by":"crossref","unstructured":"G. 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Front Neurol 2020; 11: 616097.","DOI":"10.3389\/fneur.2020.616097"},{"key":"138888","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.3389\/fneur.2020.616097","DOI":"10.3389\/fneur.2020.616097"},{"key":"138889","doi-asserted-by":"crossref","unstructured":"Chen S. Clinical uses of botulinum neurotoxins: current indications, limitations and future developments. Toxins (Basel) 2012; 4: 913\u2013939.","DOI":"10.3390\/toxins4100913"},{"key":"138890","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.3390\/toxins4100913","DOI":"10.3390\/toxins4100913"},{"key":"138891","doi-asserted-by":"crossref","unstructured":"Bavikatte G, Subramanian G, Ashford S, Allison R, Hicklin D. Early identification, intervention and management of post-stroke spasticity: expert consensus recommendations. 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Neurology 2013; 80: S13\u201319.","DOI":"10.1212\/WNL.0b013e3182762448"},{"key":"138896","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1212\/WNL.0b013e3182762448","DOI":"10.1212\/WNL.0b013e3182762448"},{"key":"138897","unstructured":"Dutch Association of Rehabilitation Physicians [Nederlandse Vereniging van Revalidatieartsen]. National guideline cerebral and\/or spinal spasticity [Richtlijn cerebrale en\/of spinale spasticiteit]; 2016. Available from https:\/\/richtlijnendatabase.nl\/richtlijn\/cerebrale_en_of_spinale_spasticiteit\/cerebrale_en_of_spinale_spasticiteit_-_startpagina.html."},{"key":"138898","unstructured":"Royal College of Physicians. Spasticity in adults: management using botulinum toxin. National guidelines; 2018. Avalable from https:\/\/www.rcp.ac.uk\/media\/i1ijs0tm\/spasticity-in-adults_final-version_march-2019.pdf"},{"key":"138899","doi-asserted-by":"crossref","unstructured":"Wissel J, Ri S. Assessment, goal setting, and botulinum neurotoxin a therapy in the management of post-stroke spastic movement disorder: updated perspectives on best practice. Expert Rev Neurother 2022; 22: 27\u201342.","DOI":"10.1080\/14737175.2021.2021072"},{"key":"138900","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1080\/14737175.2021.2021072","DOI":"10.1080\/14737175.2021.2021072"},{"key":"138901","doi-asserted-by":"crossref","unstructured":"Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2016; 86: 1818\u20131826.","DOI":"10.1212\/WNL.0000000000002560"},{"key":"138902","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1212\/WNL.0000000000002560","DOI":"10.1212\/WNL.0000000000002560"},{"key":"138903","unstructured":"Canadian Agency for Drugs and Technologies in Health (CADTH). Pharmacoeconomic review report: AbobotulinumtoxinA (Dysport Therapeutic): (Ipsen Biopharmaceuticals Canada, Inc.): Indication: For the symptomatic treatment of focal spasticity affecting the upper limbs in adults; 2017. Available from https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK534668\/"},{"key":"138904","doi-asserted-by":"crossref","unstructured":"Turner-Stokes L, Jacinto J, Fheodoroff K, Brashear A, Maisonobe P, Lysandropoulos A, et al. Longitudinal goal attainment with integrated upper limb spasticity management including repeat injections of botulinum toxin A: findings from the prospective, observational Upper Limb International Spasticity (ULIS-III) cohort study. J Rehabil Med 2021; 53: jrm00157.","DOI":"10.2340\/16501977-2801"},{"key":"138905","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.2340\/16501977-2801","DOI":"10.2340\/16501977-2801"},{"key":"138906","doi-asserted-by":"crossref","unstructured":"Rosales RL, Kong KH, Goh KJ, Kumthornthip W, Mok VC, Delgado-De Los Santos MM, et al. Botulinum toxin injection for hypertonicity of the upper extremity within 12 weeks after stroke: a randomized controlled trial. Neurorehabil Neural Repair 2012; 26: 812\u2013821.","DOI":"10.1177\/1545968311430824"},{"key":"138907","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1177\/1545968311430824","DOI":"10.1177\/1545968311430824"},{"key":"138908","doi-asserted-by":"crossref","unstructured":"Gracies JM, O\u2019Dell M, Vecchio M, Hedera P, Kocer S, Rudzinska-Bar M, et al. Effects of repeated abobotulinumtoxinA injections in upper limb spasticity. Muscle Nerve 2018; 57: 245\u2013254.","DOI":"10.1002\/mus.25721"},{"key":"138909","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1002\/mus.25721","DOI":"10.1002\/mus.25721"},{"key":"138910","doi-asserted-by":"crossref","unstructured":"Gracies JM, Esquenazi A, Brashear A, Banach M, Kocer S, Jech R, et al. Efficacy and safety of abobotulinumtoxinA in spastic lower limb: randomized trial and extension. Neurology 2017; 89: 2245\u20132253.","DOI":"10.1212\/WNL.0000000000004687"},{"key":"138911","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1212\/WNL.0000000000004687","DOI":"10.1212\/WNL.0000000000004687"},{"key":"138912","doi-asserted-by":"crossref","unstructured":"Gracies JM, Brashear A, Jech R, McAllister P, Banach M, Valkovic P, et al. Safety and efficacy of abobotulinumtoxinA for hemiparesis in adults with upper limb spasticity after stroke or traumatic brain injury: a double-blind randomised controlled trial. 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Assessing the effectiveness of upper-limb spasticity management using a structured approach to goal-setting and outcome measurement: first cycle results from the ULIS-III Study. J Rehabil Med 2021; 53: jrm00133.","DOI":"10.2340\/16501977-2770"},{"key":"138921","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.2340\/16501977-2770","DOI":"10.2340\/16501977-2770"},{"key":"138922","doi-asserted-by":"crossref","unstructured":"Egen-Lappe V, Koster I, Schubert I. Incidence estimate and guideline-oriented treatment for post-stroke spasticity: an analysis based on German statutory health insurance data. Int J Gen Med 2013; 6: 135\u2013144.","DOI":"10.2147\/IJGM.S36030"},{"key":"138923","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.2147\/IJGM.S36030","DOI":"10.2147\/IJGM.S36030"},{"key":"138924","doi-asserted-by":"crossref","unstructured":"Esquenazi A, Francisco GE, Feng W, Baricich A, Gallien P, Fanning K, et al. Real-world adherence to onabotulinumtoxinA treatment for spasticity: insights from the ASPIRE Study. Arch Phys Med Rehabil 2021; 102: 2172\u20132184 e2176.","DOI":"10.1016\/j.apmr.2021.06.008"},{"key":"138925","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1016\/j.apmr.2021.06.008","DOI":"10.1016\/j.apmr.2021.06.008"},{"key":"138926","doi-asserted-by":"crossref","unstructured":"Hull M, Anupindi VR, DeKoven M, He J, Bouchard J. Botulinum toxin utilization, treatment patterns, and healthcare costs among patients with spasticity or cervical dystonia in the US. Adv Ther 2023; 40: 3986\u20134003.","DOI":"10.1007\/s12325-023-02563-5"},{"key":"138927","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1007\/s12325-023-02563-5","DOI":"10.1007\/s12325-023-02563-5"},{"key":"138928","doi-asserted-by":"crossref","unstructured":"Woo J, Mas MF, Zhang J, Wong B, Stampas A, Francisco GE, et al. Real-world analysis of botulinum toxin (BoNT) injections in post-stroke spasticity: higher doses of BoNT and longer intervals in the early-start group. J Neurol Sci 2021; 425: 117449.","DOI":"10.1016\/j.jns.2021.117449"},{"key":"138929","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1016\/j.jns.2021.117449","DOI":"10.1016\/j.jns.2021.117449"},{"key":"138930","doi-asserted-by":"crossref","unstructured":"Levy J, Karam P, Forestier A, Loze JY, Bensmail D. Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France. Front Neurol 2023; 14: 1245228.","DOI":"10.3389\/fneur.2023.1245228"},{"key":"138931","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.3389\/fneur.2023.1245228","DOI":"10.3389\/fneur.2023.1245228"},{"key":"138932","doi-asserted-by":"crossref","unstructured":"Rakers F, Weise D, Hamzei F, Musleh R, Schwab M, Jacob J, et al. The incidence and outpatient medical care of patients with post-stroke spasticity. Dtsch Arztebl Int 2023; 120: 284\u2013285.","DOI":"10.3238\/arztebl.m2023.0004"},{"key":"138933","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.3238\/arztebl.m2023.0004","DOI":"10.3238\/arztebl.m2023.0004"},{"key":"138934","doi-asserted-by":"crossref","unstructured":"Potempa C, Thiem H, Rychlik R, Wissel J, Ebke M, Rebscher H, et al. Zur Versorgungslage von Patienten mit spastischer Bewegungsst\u00f6ring in Deutschland. Monitor Versorgungsforschung 2019; 03: 65\u201372.","DOI":"10.24945\/MVF.03.19.1866-0533.2149"},{"key":"138935","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.24945\/MVF.03.19.1866-0533.2149","DOI":"10.24945\/MVF.03.19.1866-0533.2149"},{"key":"138936","doi-asserted-by":"crossref","unstructured":"V\u00f6lkel L, Rebscher H, Rychlik R. Versorgungssituation von Patient:innen mit spastischer Bewegungsst\u00f6rung in station\u00e4ren Pflegeeinrichtungen in Deutschland. Monitor Versorgungsforschung 2022; 4: 81\u201387.","DOI":"10.24945\/MVF.04.22.1866-0533.2430"},{"key":"138937","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.24945\/MVF.04.22.1866-0533.2430","DOI":"10.24945\/MVF.04.22.1866-0533.2430"},{"key":"138938","unstructured":"Visser-Meily JMA, Achterberg WP. The rehabilition landscape is changing: the importance of collaboration [Het revalidatielandschap verandert: belang van samenwerken]. Dutch J Rehab Med [Nederlands Tijdschrift voor Revalidatiegeneeskunde] 2021: 18\u201323."},{"key":"138939","unstructured":"Nederlandse Huisartsen Genootschap (NHG). NHG-Standaard Beroerte [NHG-Standard Stroke]; 2022. Available from https:\/\/richtlijnen.nhg.org\/standaarden\/beroerte."},{"key":"138940","unstructured":"Koninklijk Nederlands Genootschap van Fysiotherapie (KNGF). 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Disabil Rehabil 2021; 43: 3688\u20133695.","DOI":"10.1080\/09638288.2020.1746843"},{"key":"138946","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1080\/09638288.2020.1746843","DOI":"10.1080\/09638288.2020.1746843"},{"key":"138947","doi-asserted-by":"crossref","unstructured":"Kerstens H, Nijkrake MJ, De Swart BJM, Nijhuis-van der Sanden RWG, Vos-van de Hulst M, Bos GJ, et al. Online monitoring of focal spasticity treatment with botulinum toxin in people with chronic stroke or hereditary spastic paraplegia: a feasibility study. J Rehabil Med 2023; 55: jrm00383.","DOI":"10.2340\/jrm.v55.6572"},{"key":"138948","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.2340\/jrm.v55.6572","DOI":"10.2340\/jrm.v55.6572"},{"key":"138949","unstructured":"Zorgwijzer. 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