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Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualised, flexible injection regimens.
Neurol Sci 2005; 26(1):32-9NS

Abstract

Current antispastic medications are unsatisfactory for spasticity treatment, but botulinum toxin type A (BTX-A) shows promise as a new therapeutic option. This open-label, prospective study aimed to assess the effectiveness of BTX-A in improving functional mobility in the early post-stroke population using an individualised, flexible range of doses and targeted muscle groups. Twenty-one stroke patients (13 male, 8 female) were enrolled and injected with BTX-A (Botox, Allergan, mean dose: 255 U; range: 185-300) according to individual spasticity patterns. Assessments were made at baseline and weeks 2, 4, 6, 10 and 16 post-treatment. Outcome measures comprised: Modified Ashworth Scale (MAS), finger flexion scale (Bhakta), MRC scale, Physician's Rating Scale (PRS), Nine Hole Peg Test (9HPT), Motor Assessment Scale, Clinical Global Impression (CGI), Global Assessment of Spasticity (GASS) and Visual Analogue Scale (VAS) for pain assessment. Statistically significant improvements in muscle tone as determined by the MAS were found in all areas (except arm) till week 16 (p<0.05). Finger positioning improved for the study duration, whilst muscle power increased only slightly in specific muscles. PRS revealed significant improvements to week 10 and slight improvement in 9HPT performance in selected patients was observed. Motor Assessment Scale results were statistically significant for arm, hand and advanced hand functions, although the overall functional benefit was mild. GASS and CGI results also showed improvement. Pain was present only in 11 patients and did not significantly improve following treatment. Individualised BTX-A injection regimens may be an effective, reversible and safe new treatment option for patients with spasticity. Nevertheless, functional improvement may be reached only in selected patients.

Authors+Show Affiliations

Department of Neurosurgery, Division of Movement Disorders and Functional Neurosurgery, Medical University, ul. Debinki 7, 80-211, Gdansk, Poland. jaroslawek@amg.gda.plNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15877185

Citation

Slawek, J, et al. "Botulinum Toxin Type a for Upper Limb Spasticity Following Stroke: an Open-label Study With Individualised, Flexible Injection Regimens." Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, vol. 26, no. 1, 2005, pp. 32-9.
Slawek J, Bogucki A, Reclawowicz D. Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualised, flexible injection regimens. Neurol Sci. 2005;26(1):32-9.
Slawek, J., Bogucki, A., & Reclawowicz, D. (2005). Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualised, flexible injection regimens. Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 26(1), pp. 32-9.
Slawek J, Bogucki A, Reclawowicz D. Botulinum Toxin Type a for Upper Limb Spasticity Following Stroke: an Open-label Study With Individualised, Flexible Injection Regimens. Neurol Sci. 2005;26(1):32-9. PubMed PMID: 15877185.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualised, flexible injection regimens. AU - Slawek,J, AU - Bogucki,A, AU - Reclawowicz,D, PY - 2004/09/30/received PY - 2005/02/19/accepted PY - 2005/5/7/pubmed PY - 2005/7/21/medline PY - 2005/5/7/entrez SP - 32 EP - 9 JF - Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology JO - Neurol. Sci. VL - 26 IS - 1 N2 - Current antispastic medications are unsatisfactory for spasticity treatment, but botulinum toxin type A (BTX-A) shows promise as a new therapeutic option. This open-label, prospective study aimed to assess the effectiveness of BTX-A in improving functional mobility in the early post-stroke population using an individualised, flexible range of doses and targeted muscle groups. Twenty-one stroke patients (13 male, 8 female) were enrolled and injected with BTX-A (Botox, Allergan, mean dose: 255 U; range: 185-300) according to individual spasticity patterns. Assessments were made at baseline and weeks 2, 4, 6, 10 and 16 post-treatment. Outcome measures comprised: Modified Ashworth Scale (MAS), finger flexion scale (Bhakta), MRC scale, Physician's Rating Scale (PRS), Nine Hole Peg Test (9HPT), Motor Assessment Scale, Clinical Global Impression (CGI), Global Assessment of Spasticity (GASS) and Visual Analogue Scale (VAS) for pain assessment. Statistically significant improvements in muscle tone as determined by the MAS were found in all areas (except arm) till week 16 (p<0.05). Finger positioning improved for the study duration, whilst muscle power increased only slightly in specific muscles. PRS revealed significant improvements to week 10 and slight improvement in 9HPT performance in selected patients was observed. Motor Assessment Scale results were statistically significant for arm, hand and advanced hand functions, although the overall functional benefit was mild. GASS and CGI results also showed improvement. Pain was present only in 11 patients and did not significantly improve following treatment. Individualised BTX-A injection regimens may be an effective, reversible and safe new treatment option for patients with spasticity. Nevertheless, functional improvement may be reached only in selected patients. SN - 1590-1874 UR - https://www.unboundmedicine.com/medline/citation/15877185/Botulinum_toxin_type_A_for_upper_limb_spasticity_following_stroke:_an_open_label_study_with_individualised_flexible_injection_regimens_ L2 - https://dx.doi.org/10.1007/s10072-005-0379-8 DB - PRIME DP - Unbound Medicine ER -