Stroke is the third leading cause of death in America. According to the American Stroke Association, a stroke occurs every 40 seconds and someone dies of a stroke every four minutes, making it a major health concern in the United States. For these reasons, New York Methodist Hospital (NYM), a New York State Department of Health-designated stroke center, has a full team of neurologists on call, 24 hours a day, to provide stroke patients with access to immediate diagnosis and treatment.

Jeffrey Benjamin, M.D., a stroke specialist at New York Methodist Hospital, says that a stroke occurs when a blood clot blocks an artery or a blood vessel breaks, stopping blood flow to an area of the brain. When this happens, brain cells start to die and brain damage occurs. A lifetime of learning can be lost in mere minutes and the ability to speak or to move upper and lower limbs may be impaired or lost entirely. In many cases, speech, physical and occupational therapy can improve or bring back speech and language and/or small and large motor function.

Some effects of stroke may develop over time. One of the most debilitating of these--upper limb spasticity, is a condition that results in tight, stiff muscles or spasms in the elbow, wrist and fingers. People living with upper limb spasticity may have an arm pinned against their chest, a flexed elbow or wrist that can't be straightened without discomfort or force, or a hand clenched in to a tight, balled-up fist. Sometimes spasticity is so severe that it gets in the way of daily activities and even sleep patterns.
While some spasticity improves with regular stretching of the affected muscles, stretching alone may not provide good results for all patients. For this reason, botulinum toxin (Botox), was recently approved by the U.S. Food and Drug Administration as a treatment option for individuals with upper limb spasticity. It is now offered at New York Methodist Hospital. Botulinum toxin works by blocking the release of acetycholine, a substance that transmits signals from the nerves to the muscles and can cause the muscles to overreact and tense up if present in large amounts.

When the drug is injected into the affected area, muscle spasms may cease or be greatly reduced. The use of botulinum toxin has very few risks. However, the effects are not permanent and generally wear off in three to four months, at which time the injection must be repeated.

Upper limb spasticity is common after a stroke, but it may also occur after a spinal cord or traumatic brain injury or in adults with multiple sclerosis or a history of cerebral palsy. The botulinum toxin injection can also be used to treat the conditions in these patients. "The drug is also used at the Hospital to treat spasticity due to other neurological conditions like spinal cord or traumatic brain injury, multiple sclerosis or cerebral palsy or movement disorders such as cervical dystonia (involuntary contracting of the neck muscles), and hemifacial spasms (involuntary twitching of muscles in the face)," said Miran Salgado, M.D., chairman of neurosciences.

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