S pastic paresis is a complex condition associated with damage to the upper motor neurons, typically caused by cerebral palsy, multiple sclerosis, stroke or trauma. Despite substantial impact on patients' independence and burden on caregivers, there is a lack of consensus on optimal management of this condition and the patient journey remains unclear. A group of physicians, experienced in spasticity management, recently convened with the objective of analysing the patient journey from a care pathway perspective in different geographical regions and under different conditions from acute phase to long-term/chronic disease status. The experts reviewed results from recent patient and healthcare practitioner surveys on the subject and assessed how current patient pathways could be improved, using their own experiences to highlight the issues related to management deficiencies in their individual countries. The group divided the patient journey into steps, considering the evidence from the point of view of healthcare practitioners, patients, caregivers and funders/payors. This paper is a response to the lack of consensus on the optimal management of spastic paresis, and acts as a call to action to develop a consistent care pathway that could be applied across a broad range of illnesses, using an interdisciplinary approach. KeywordsSpastic paresis, patient rehabilitation, patient journey, patient care, care pathway Disclosure: David Bowers has participated in an advisory board for Ipsen and has been a trainer for Allergan and Medtronic. Klemens Fheodoroff has received unrestricted research grants from Ipsen and Merz, and honoraria for instructional courses from Ipsen, Allergan and Merz. Patricia Khan has participated in advisory boards for Ipsen, and has received honoraria for instructional courses from Ipsen and Allergan. Julian P Harriss has received research funding into current practice in spasticity management (the SPACE study, supported by Merz Pharma) and expenses for participation in expert panels (Ipsen). Khashayar Dashtipour has received compensation/honoraria for services as a consultant or an advisory committee member or speaker from Allergan, Inc., Ipsen Biopharmaceuticals, Inc., Lundbeck Inc., Merz Pharmaceuticals, Teva Pharmaceutical Industries Ltd., UCB Inc., Impax Pharmaceutical and US World Meds. Laxman Bahroo has received personal compensation from Teva Neuroscience, UCB pharma, Impax, Allergan, Ipsen, US World Meds, AbbVie, Lundbeck and Acadia for consulting, serving on a scienti c advisory board or speaking activities, and research support from Ipsen and Teva Neuroscience. Michael Lee has participated in an advisory board for Ipsen. Denis Zakharov has received personal compensation from Ipsen and Merz for consulting, serving on a scienti c advisory board or speaking activities. Jovita Balcaitiene is an employee of Ipsen Pharma. Virgilio Evidente has received research support from Ipsen and honoraria for consulting and/or speaking from Ipsen, Merz, Solstice, US WorldMeds, Lundbeck, UCB, Xenoport, Te...

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The issues of neurorehabilitation of stroke patients are considered. The importance of the phenomenon of neuroplasticity, which underlies the regenerative processes after brain damage is emphasized. The principles of rehabilitation therapy in stroke patients are considered. Particular attention is paid to the issue of pharmacotherapy through neurotransmitters focused on increasing neuroplasticity and neurogenesis.

Despite nearly 30 years of experience in the application of botulinum toxin type A (BTA) in clinical practice, many fundamental questions of therapy remain valid. There are 5 botulinum toxin type A used for neurological indications in the Russian Federation in 2017. They contain different number of active neuroprotein (150 kDa) in a therapeutic dose of the drug that may have a potential impact on the efficacy and duration of action. The current SmPC of each BTA stated that the unit of activity is unique and can not be compared with any other BTA. In scientific publications one can find many details concerning the equivalence doses of onabotulinumtoxin A (botox) and abobotulinumtoxin A (dysport) and the ratio of units varies from 1:1 to 1:11. However, according to clinical guidelines, systematic reviews and high quality research evidence of recent years, the ratio of units of abobotulinumtoxin A (dysport) and onabotulinumtoxin A (botox) is 3(2,5):1. Use of a fixed ratio of units is possible only when switching from one drug to another or in case of limiting access to specific drug. Botulinum toxin type A is the first line of therapy in the treatment of several neurological diseases. The most commonly used drugs of botulinum toxin type A (botox, dysport, xeomin) have a significant evidence base that confirms their efficacy and optimal safety profile. The main difference between botulinum toxin type A is their potential activity of action, i.e., activity units and total therapeutic dose.