Botulinum toxin produced beneficial effects in spasticity in the hemiplegic upper limb. This study will test if botulinum toxin injections at earlier phases (<or = 3 months) in spasticity improve functional and motor tests compared with late injections (>or = 6 months).

Inclusion Criteria:

• Minimum age 18

• Spastic hemiplegia after ischemic stroke (carotid occlusion) within the past 3 months.

• Antispasticity medication stabilized for the last 30 days

• Severe cognitive impairment such that patient is unable to provide scale assessment.

• Significant spasticity impeding improvement by re-education for 2 months or less

• Lack of muscular retraction defined by a minimal range of articular motion as :

  • finger : complete extension and rolling up
  • wrist : extension 40°/flexion : 45°
  • elbow : extension - 10°/flexion : 120°
  • shoulder : Enjalbert score 2 or more

• Antagonist muscles (to spasticity) activity score 1 or more

• Social Security benefits

Exclusion Criteria:

• Ischemic stroke thought to be due to basilar or vertebral vessel occlusion
• Known motor neuron or neuromuscular junction disease, disorders in which pain limits the ability to inject muscles (algodystrophy)
• Absence of mobility in proximal part of upper limb that does not predict a functional gain
• Minor stroke with non-disabling deficit or rapidly improving motor symptoms
• other serious illness, e.g. severe hepatic, cardiac, or renal failure ; acute myocardial infarction ; or a complex disease that may confound treatment assessment
• Treatment of spasticity by previous administration of botulinum toxin, if known
• Known allergy to botulinum toxin
• Currently participating in other research studies