About 1/3 of stroke patients, 60% of patients with severe multiple sclerosis, and 75% of patients after severe traumatic brain injury will develop spasticity requiring therapeutic intervention; ● Cosmetic wrinkle removal is only a small part of the indications for botulinum toxin, which is now the first-line drug for the treatment of primary cranial and cervical dystonia, etc. Morbidity: Stroke is one of the common neurological disorders, with about 1.5 million new stroke patients each year in China, of which about 69% may present with upper limb spasticity. Although there are no accurate figures on the prevalence of limb spasticity, clinical estimates suggest that spasticity requiring treatment occurs in approximately 1/3 of stroke patients, 60% of patients with severe multiple sclerosis, and 75% of patients with physical disability following severe traumatic brain injury. These patients, if not treated aggressively, can result in permanent increased muscle tone, intractable pain, and joint contractures in the spastic limb, affecting limb coordination, resulting in moderate to severe disability and severely affecting the patient’s quality of life. Treatment: Traditional treatments for post-stroke muscle spasm include oral medications, nerve blocks, surgical treatment, and physical therapy, but all have limitations. Drugs such as baclofen and diazepam can improve muscle hyperactivity by decreasing central nervous system or muscle excitability, but have limited efficacy and are dose dependent, and can lead to adverse effects such as weakness and drowsiness. Surgical treatment may produce serious irreversible complications such as sensory loss and excessive muscle weakness, thus limiting its widespread use. Currently, physical therapy is considered to help prevent muscle contractures, but cannot be applied to patients with severe spasticity. In addition, EMG biofeedback can be effective in reducing muscle tone during treatment, but the efficacy is usually not sustained. Botulinum toxin, as a neuromuscular blocking agent, has been increasingly used clinically in the treatment of muscle spasticity since 1989, when Das and Park reported the use of botulinum toxin in adults with post-stroke limb spasticity. in December 1989, the US FDA officially approved botulinum toxin type A as a clinical therapeutic agent, making it the first microbial toxin used clinically in the world. Compared with traditional muscle relaxants, neurological drugs and physical therapy, botulinum toxin has the advantages of simplicity, rapid onset, obvious effect, no pain and few side effects in relieving muscle spasms, and has become the first-line treatment drug for primary cranial and cervical dystonia and writing spasms. Many people know that Botox can be used for cosmetic wrinkle removal, but in fact, this is only part of its indications. Currently, the indications approved for use in China also include muscle spasm, strabismus, primary axillary hyperhidrosis, etc. Other indications such as chronic pain, migraine, urinary disorders, etc. can also be used, and there have been very good results in clinical practice. Reminder: The timing of Botox injection should be appropriate. Not all people with muscle spasms in the limbs after stroke need to be treated with Botox, for example, patients with less severe spasms and not so much as to have doubts about joint deformation may be improved with physical therapy. However, if the spasm is so severe or the muscle tension is so strong that it significantly affects the movements of daily life, such as the inability to open the palm of the hand to hold something, the inability to lift the hand to change clothes, the inversion of the foot that makes it impossible to practice walking or even fall, or if the muscle tension is so great that the limb is contracted and difficult to clean, or if the muscle spasm causes joint deformation, or if the muscle tension is so great that it causes pain and discomfort or even sleeplessness at night, you may consider Botox is used to improve the situation. Usually the use of Botox is very effective in improving muscle spasms, but it is unrealistic to have excessive expectations of Botox and not to expect to recover to the previous state at once. Not only is it important to evaluate the right patient before use for better results, but it is also very important to have continuous rehabilitation after Botox injection in order to make gradual improvement in motor function after stroke. In addition, the timing of botulinum toxin use should be appropriate, and each patient’s disease r progression is different, so individualized assessment is necessary. The clinical changes of stroke often stabilize after six months, and sometimes the muscle tone seems to be strong only temporarily, so if Botox is injected too early, the muscle weakness may be detrimental to recovery. Unless the muscle tone is really too high, it can be used earlier, but the dosage must be controlled.