A Study to Compare the Safety and Efficacy of Dysport® and Botox® in Adults With Upper Limb Spasticity.

Inclusion Criteria:

• Participant must be 18 to 80 years of age inclusive, at the time of signing theinformed consent

• 2a. [US/France] Participants with stable Upper Limb Spasticity (ULS) for at least 3months, in whom treatment of only one upper limb is necessary for the duration ofthe study;

• 2b. [Canada] Participants with stable post-stroke ULS for at least 3 months, in whomtreatment of only one upper limb is necessary for the duration of the study

• Participants who are either naïve to Botulinum toxin type A (BoNT-A) for ULS or whohave been previously treated with BoNT-A for ULS;

• Participants with MAS score of at least 2 at two muscle groups (one of these twomuscles groups should be the PTMG) and at least 1 in the remaining muscle group.

• Participants with DAS score of at least 2 on the Principal Target of Treatment (PTT) (one of four functional domains: dressing, hygiene, limb position and pain);

• Participants who require BoNT-A injection in all of the following muscles: flexorcarpi radialis, flexor carpi ulnaris, flexor digitorum profundus, flexor digitorumsuperficialis and biceps brachii;

• Participants for whom injection of a total dose of 900 Units aboBoNT-A or 360 UnitsonaBoNT-A is considered by the investigator to be clinically appropriate;

• Participants who have been stable for at least 3 months prior to study entry interms of oral antispasticity, anticoagulant and/or anticholinergic medication iftreated are considered by the investigator likely to remain stable for the durationof the study;

Exclusion Criteria:

• Major limitations in the passive range of motion in the paretic upper limb;

• Major neurological impairment (other than limb paresis) that could negatively affectfunctional performance;

• Participants clinically requiring injection into any upper limb muscles other thanthe five muscles of one arm listed in Section 5.1, or requiring injection into botharms or any lower limb within the timeframe of the study;

• Hypersensitivity to any BoNT product or excipients;

• Hypersensitivity to cow's milk protein (casein);

• Infection at the proposed injection site(s);

• Known peripheral motor neuropathic diseases, amyotrophic lateral sclerosis orneuromuscular junction disorders (e.g. myasthenia gravis or Lambert-Eaton syndrome);

• Any medical condition (including dysphagia or breathing difficulties/compromisedrespiratory function) that in the opinion of the investigator, might jeopardize theparticipant's safety;

• Women who are pregnant or lactating

• Participants treated with BoNT of any type for any indication (e.g. bladderinjection, headache or cosmetic) within the previous 12 weeks or planned/likely tobe treated during the course of the study;

• Prior history of non-responsiveness to BoNT treatment;

• Previous surgery, or administration of alcohol or phenol in the study limb 6 monthsor earlier from study enrolment or planned/likely to be treated during the course ofthe study;

• Participants treated with intrathecal baclofen (except if treatment has reached astable dose for >4 weeks and is likely to remain stable throughout the study),aminoglycosides or other agents interfering with neuromuscular transmission (e.g.curare-like agents) within the 4 weeks prior to study enrolment or planned/likely tobe treated during the course of the study

• BoNT naïve participants with a history of facial neurogenic disorder (facialparalysis, polyradiculoneuropathy) (only for France).

• Participants receiving concomitant medication treatment with the following PT/OTinterventions on the study limb: new splinting/orthotics/casting, serial casting,shockwave therapy, dry needling and needle tenotomies. However, PT/OT interventionsnot intended to reduce study limb spasticity (e.g. functional training exercises) orwith a transient (<1 day) reduction of study limb spasticity (e.g. stretching,weight bearing) are allowed.