{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:03:04Z","timestamp":1760230984871,"version":"build-2065373602"},"reference-count":49,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T00:00:00Z","timestamp":1660867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Botulinum Neurotoxin type-A (BoNT-A) is the treatment of choice for focal post-stroke spasticity (PSS). Due to its mechanism of action and the administration method, some authors raised concern about its possible systemic diffusion leading to contralateral muscle weakness and autonomic nervous system (ANS) alterations. Stroke itself is a cause of motor disability and ANS impairment; therefore, it is mandatory to prevent any source of additional loss of strength and adjunctive ANS disturbance. We enrolled 15 hemiparetic stroke survivors affected by PSS already addressed to BoNT-A treatment. Contralateral handgrip strength and ANS parameters, such as heart rate variability, impedance cardiography values, and respiratory sinus arrythmia, were measured 24 h before (T0) and 10 days after (T1) the ultrasound (US)-guided BoNT-A injection. At T1, neither strength loss nor modification of the basal ANS patterns were found. These findings support recent literature about the safety profile of BoNT-A, endorsing the importance of the US guide for a precise targeting and the sparing of \u201ccritical\u201d structures as vessels and nerves.<\/jats:p>","DOI":"10.3390\/toxins14080564","type":"journal-article","created":{"date-parts":[[2022,8,22]],"date-time":"2022-08-22T01:56:40Z","timestamp":1661133400000},"page":"564","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Lack of Systemic and Subclinical Side Effects of Botulinum Neurotoxin Type-A in Patients Affected by Post-Stroke Spasticity: A Longitudinal Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1357-1374","authenticated-orcid":false,"given":"Marco","family":"Battaglia","sequence":"first","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"},{"name":"Physical and Rehabilitation Medicine, \u201cOspedale Maggiore della Carit\u00e0\u201d University Hospital, 28100 Novara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margherita Beatrice","family":"Borg","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"},{"name":"Physical and Rehabilitation Medicine, \u201cOspedale Maggiore della Carit\u00e0\u201d University Hospital, 28100 Novara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6885-6206","authenticated-orcid":false,"given":"Lara","family":"Torgano","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"},{"name":"Physical and Rehabilitation Medicine, \u201cOspedale Maggiore della Carit\u00e0\u201d University Hospital, 28100 Novara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8116-4802","authenticated-orcid":false,"given":"Alberto","family":"Loro","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"},{"name":"Physical and Rehabilitation Medicine, \u201cOspedale Maggiore della Carit\u00e0\u201d University Hospital, 28100 Novara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Cosenza","sequence":"additional","affiliation":[{"name":"Rehabilitation Unit, Department of Rehabilitation, \u201cSanti Antonio e Biagio e Cesare Arrigo\u201d National Hospital, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Bertoni","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, ASST Sette Laghi, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-8276","authenticated-orcid":false,"given":"Alessandro","family":"Picelli","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy"},{"name":"Neurorehabilitation Unit, Department of Neurosciences, University Hospital of Verona, 37126 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1452-8485","authenticated-orcid":false,"given":"Andrea","family":"Santamato","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Spasticity and Movement Disorder Unit, Policlinico Riuniti, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5141-0681","authenticated-orcid":false,"given":"Marco","family":"Invernizzi","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"},{"name":"Dipartimento Attivit\u00e0 Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, \u201cSanti Antonio e Biagio e Cesare Arrigo\u201d National Hospital, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5751-270X","authenticated-orcid":false,"given":"Francesca","family":"Uberti","sequence":"additional","affiliation":[{"name":"Human Physiology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Molinari","sequence":"additional","affiliation":[{"name":"Human Physiology, Department of Sustainable Development and Ecological Transition, Universit\u00e0 del Piemonte Orientale, 13100 Vercelli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Carda","sequence":"additional","affiliation":[{"name":"Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, 1004 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8440-6283","authenticated-orcid":false,"given":"Alessio","family":"Baricich","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"},{"name":"Physical and Rehabilitation Medicine, \u201cOspedale Maggiore della Carit\u00e0\u201d University Hospital, 28100 Novara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1177\/15459683211011214","article-title":"A New Definition of Poststroke Spasticity and the Interference of Spasticity With Motor Recovery From Acute to Chronic Stages","volume":"35","author":"Li","year":"2021","journal-title":"Neurorehabilit. 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