Bensmail Djamel, Forestier Anne, Loze Jean-Yves, Karam Pierre
Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital AP-HP, Université Paris-Saclay, Garches, France.
Unité INSERM 1179, University of Versailles Saint-Quentin-En-Yvelines, Montigny-Le-Bretonneux, France.
Eur Stroke J. 2025 Sep 19:23969873251374771. doi: 10.1177/23969873251374771.
Botulinum neurotoxin type A (BoNT-A) is a well-established treatment for post-stroke spasticity. However, its real-world use remains underexplored. This study evaluated BoNT-A use trends among stroke survivors in France from 2015 to 2023.
A retrospective cohort study was conducted using data from the French National Hospital Discharge Database. We analyzed stroke hospitalizations and BoNT-A treatment rates by age and care pathway. Among patients presenting with stroke between 2017 and 2019 who survived beyond 6 months post-stroke, we estimated the prevalence of patients with coded post-stroke spasticity, BoNT-A use, and time from stroke onset to spasticity coding and the first BoNT-A injection.
Between 2015 and 2023, 1,170,436 hospitalizations for stroke were recorded in France. BoNT-A treatment rates remained low, ranging from 1.4% in 2015 to 1.9% in 2022. BoNT-A treatment rates increased from 3.3% to 3.8% in stroke survivors aged 20-29 and from 1.0% to 1.6% in those aged 70-79 between 2015 and 2022. Patients who, during their care pathway, stayed in a neurovascular or neurorehabilitation unit were more likely to receive BoNT-A treatment-rising from 2.0% in 2015 to 2.6% in 2022 and 7.3% to 9.6%, respectively-than those managed in non-specialized units, where rates increased from 0.9% in 2015 to 1.1% in 2022. Among 287,370 patients presenting with stroke between 2017 and 2019, 37,692 (13.1%) were coded with post-stroke spasticity, 8056 (2.8%) received ⩾1 BoNT-A injection between 2017 and 2023, 4360 (1.5%) received ⩾3 injections, and 1003 (0.35%) received ⩾3 injections spaced ⩽6 months apart. The median time from stroke onset to spasticity coding was 96 days, and to the first BoNT-A injection 258 days.
BoNT-A remains underutilized in the treatment of post-stroke spasticity in France. These results emphasize the need to enhance access to and adherence to BoNT-A therapy to optimize post-stroke spasticity management.
A型肉毒杆菌神经毒素（BoNT-A）是一种成熟的中风后痉挛治疗方法。然而，其在现实世界中的应用仍未得到充分探索。本研究评估了2015年至2023年法国中风幸存者中BoNT-A的使用趋势。
使用法国国家医院出院数据库的数据进行回顾性队列研究。我们按年龄和护理途径分析了中风住院情况和BoNT-A治疗率。在2017年至2019年间中风且存活超过中风后6个月的患者中，我们估计了有中风后痉挛编码的患者患病率、BoNT-A的使用情况以及从中风发作到痉挛编码和首次BoNT-A注射的时间。
2015年至2023年期间，法国记录了1170436例中风住院病例。BoNT-A治疗率仍然较低，从2015年的1.4%到2022年的1.9%不等。2015年至2022年间，20 - 29岁中风幸存者的BoNT-A治疗率从3.3%升至3.8%，70 - 79岁者从1.0%升至1.6%。在护理过程中入住神经血管或神经康复单元的患者比在非专科单元接受治疗的患者更有可能接受BoNT-A治疗，前者的治疗率从2015年的2.0%升至2022年的2.6%，后者从2015年的0.9%升至2022年的1.1%。在2017年至2019年间中风的287370例患者中，37692例（13.1%）有中风后痉挛编码，8056例（2.8%）在2017年至2023年间接受了≥1次BoNT-A注射，4360例（1.5%）接受了≥3次注射，1003例（0.35%）接受了间隔≤6个月的≥3次注射。从中风发作到痉挛编码的中位时间为96天，到首次BoNT-A注射的中位时间为258天。
在法国，BoNT-A在中风后痉挛治疗中的使用仍未得到充分利用。这些结果强调需要增加BoNT-A治疗的可及性并提高其依从性，以优化中风后痉挛的管理。
