Inclusion CriteriaSubjects eligible for enrolment in the study must meet all of the following criteria:
1. Subjects with upper limb spasticity who are at least 6 months post stroke and present with spasticity of both the wrist and fingers in the study limb.
2. Wrist flexor muscle tone of 3 or greater and finger flexor muscle tone of 2 or greater as measured on MAS (0 to 4).
3. At least one functional disability item (i.e., hygiene, dressing, pain, or cosmesis) with a rating of 2 or greater on DAS (0 to 3).
4. If using oral anti-spasticity medications, must be stable for at least 1 month prior to study enrolment
5. If using physical therapy, must be stable for at least 1 month prior to study enrolment.
6. Male or female 18 to 75 years old at the time of informed consent.
7. >=40kg in weight.
8. QTc criteria: (either QTcb or QTcf, machine or manual overread, males or females); include the following details as appropriate: QTc<450 millisecond (msec) or <480msec for subjects with Bundle Branch Block-values based on either single electrocardiogram (ECG) values or triplicate ECG averaged QTc values obtained over a brief recording period.
9. Liver function tests: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) <2xULN; alkaline phosphatase and bilirubin ≤1.5xULN (isolated bilirubin >1.5ULN is acceptable if bilirubin is fractionated and direct bilirubin <35%).
10. In the opinion of the investigator, subject must clearly understand the intent of the study and be willing and able to comply with study instructions and complete the entire study.
11. Informed consent has been obtained.
Exclusion CriteriaSubjects meeting any of the following criteria must not be enrolled in the study:
1. Presence of fixed contracture of the study limb (absence of passive range of motion).
2. Profound atrophy of muscles to be injected (in the investigators opinion).
3. Infection or dermatological condition at the injection sites.
4. Significant inflammation in the study limb limiting joint movement.
5. History of or planned treatment for spasticity with phenol or alcohol block in the study limb.
6. History of or planned surgical intervention for spasticity of the study limb.
7. History (within 3 months of qualification) of or planned (during study period) casting of the study limb.
8. Participation in another clinical study currently, or within the 30 days immediately prior to enrolment.
9. Previous or current botulinum toxin therapy of any serotype.
10. Planned or anticipated initiation of new antispasticity medications during the clinical study.
11. Any medical condition that may put the subject at increased risk with exposure to GSK1358820, including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or any other disorder that might have interfered with neuromuscular function.
12. Concurrent use of aminoglycoside antibiotics or other agents that might interfere with neuromuscular function. A full list of prohibited medications that interfere with neuromuscular transmission is provided as Appendix 1.
13. Current treatment for spasticity with an intrathecal baclofen.
14. Females who are pregnant, nursing, or planning a pregnancy during the study period, or females of childbearing potential, not using a reliable means of contraception.
15. Known allergy or sensitivity to study medication or its components.
16. Bedridden subjects.
17. Unstable liver disease (as defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminaemia, esophageal or gastric varices or persistent jaundice), cirrhosis, known biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones).
18. Presence of clinically unstable severe cardiovascular, renal or respiratory disease.
19. Investigator's opinion that the subject has a concurrent condition(s) that may put the subject at significant risk, may confound the study results, or may interfere significantly with the conduct of the study.