HEMITOX : Effect of Botulinum Toxin Injections on Motor and Functional Ability of Upper Limb in Adults at Earlier Phases of Spastic Hemiplegia After Stroke

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