Some recent studies in children with spasticity demonstrated the safety of multimuscle injections of botulinum toxin (BT) type A with doses markedly higher than those recommended. Data about efficacy and safety of multifocal injections of BT in adult patients with spasticity are very limited. However numerous clinical situations for example, spinal cord injury, multiple sclerosis, brain injury, stroke or cerebral palsy seem to justify this type of patient management. Controlled studies are expected in the future to evaluate the efficacy and safety of multisite injections of BT. They may encourage physicians to perform such multifocal injections with high doses of BT. A better understanding of distant spread of BT is also warranted.