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This is a combination therapy of botulinum toxin type A, a neurotoxin that inhibits acetylcholine release at neuromuscular junctions to induce local muscle relaxation and reduce spasticity, with tizanidine, an oral centrally acting alpha-2 adrenergic receptor agonist that reduces spasticity by presynaptic inhibition of motor neurons. The combination has been studied primarily in the management of spasticity (notably in children with cerebral palsy), where it appears to be more effective and have fewer side effects than combinations such as botulinum toxin type A plus baclofen. Botulinum toxin type A acts peripherally at the neuromuscular junction while tizanidine acts centrally on spinal polysynaptic pathways[1][5][6][9].
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