Is The Insuffıcıent Patıent Informatıon An Overlooked Barrıer To Dıscontınuıng Bont-A Therapy For Post-Stroke Spastıcıty? A Retrospectıve Cohort Study
Conditions: Post Stroke Spastic Hemiplegia
Sponsor: Suleyman Demirel University

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IS THE INSUFFICIENT PATIENT INFORMATION AN OVERLOOKED BARRIER TO 
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DISCONTINUING BONT-A THERAPY FOR POST-STROKE SPASTICITY? A 
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RETROSPECTIVE COHORT STUDY 
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Halenur YAMAN1,*, Serpil SAVAŞ1  
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1Süleyman Demirel University Medical School, Department of Physical Medicine and 
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Rehabilitation, Isparta, Türkiye 
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*Correspondence: halenuryaman1@gmail.com 
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Halenur YAMAN/ Assıstant Doctor: 
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https://orcid.org/0009-0007-8738-6071 
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halenuryaman1@gmail.com 
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Serpil SAVAŞ/ Professor Doctor: 
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https://orcid.org/0000-0003-4601-534X 
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serpilsavas@yahoo.com 
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02462119281 
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IS THE INSUFFICIENT PATIENT INFORMATION AN OVERLOOKED BARRIER 
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TO DISCONTINUING BONT-A THERAPY FOR POST-STROKE SPASTICITY? A 
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RETROSPECTIVE COHORT STUDY. 
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  Abstract 
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Purpose: This study aims to evaluate patient adherence to botulinum toxin (BoNT-A) 
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treatment and identify the factors contributing to its discontinuation. 
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 Methods: This retrospective cohort study analyzed the medical records of patients who 
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received at least one botulinum toxin treatment for post-stroke spasticity (PSS) from 2012 to 
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2024. Eighty-one enrolled patients responded to structured questions about their reasons for 
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not consistently continuing BoNT-A treatment. 
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Results: The mean age of patients receiving BoNT-A treatment was 53.5 years. Patients 
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received a total of 154 injections over the 12 years. The mean number of injections was 1.9 
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(range 1-7), and the mean interval between consecutive injections was 13,3 months. Forty- 
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seven patients (58.02%) discontinued treatment after only one injection. The leading cause for 
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treatment discontinuation among all patients was a lack of awareness about the necessity of 
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continued therapy, as their clinicians failed to inform them (49.4%). Other reasons for 
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discontinuing treatment included lack of benefits from the injection (33,3%), reduced spasticity 
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(14,81%), other health issues (9,25%), ongoing treatment elsewhere (12,96%), fear of injections 
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(5,55%), inability to take time off work (1,85%), and misinformation about coverage for the 
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BoNT-A injection. 
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Conclusion: Most PSS patients received only one BoNT-A injection over 12 years. The 
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primary reason cited for discontinuing BoNT-A therapy was a lack of awareness about the 
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necessity of ongoing treatment. The intervals between injections were extended and irregular 
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for patients who continued therapy. Adequate education from clinicians regarding BoNT-A 
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treatment can promote patient engagement and improve adherence. 
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  Key words: Botulinum toxin, Spasticity, Stroke, Treatment Discontinuation 
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