Effectiveness of botulinum toxin A in the treatment of spasticity of the lower extremities in adults - preliminary report (original) (raw)
Related papers
Treatment of spasticity with botulinum toxin: A double-blind study
Annals of Neurology, 1990
We studied the effect of botulinum-A toxin on spasticity of the leg adductors in 9 patients who were either chairbound or bed-bound with chronic stable multiple sclerosis. We injected botulinum toxin (400 mouse units) or placebo into the adductor muscles in a randomized, crossover, double-blind design. Two physicians, who were unaware of the treatment order, used an objective rating scale and independently assessed the patients; interobserver correlation was excellent (r = 0.93-0.81). We found that botulinum toxin produced a significant reduction in spasticity ( p = 0.009) and a significant improvement in the ease of nursing care ($ = 0.009). There were no adverse effects during this shortterm trial. This is the first demonstration of the beneficial effect of botulinum toxin on focal spastic muscle contractions.
Comparative Study of Botulinum Toxin ‘A’ on Upper and Lower Limb Spasticity: A Clinical Aspect
Indian Journal of Physical Medicine and Rehabilitation, 2021
Aims and objectives: The study intended to compare the effect of botulinum toxin A on clinical aspects of spasticity recorded in various scales. It compared the data of upper and lower limb spasticity. Materials and methods: This is an open-level prospective controlled study, involving patients with upper and lower limb spasticity. Assessment at 3, 12, and 24 weeks post-injections. The modified Ashworth, modified Tardieu scale of spasticity, percentage of passive range motion, Motricity Index for fine and gross motor activity were used. A total of 34 patients were enrolled-25 males, 9 females. There were 51 upper limb and 49 lower limb muscle groups. Three patients were lost after 3 weeks post-baseline follow-up. Results: There was a significant improvement in all the parametric variables post-injections. Aggregate outcome scores comparing groups post-baseline showed a significant difference in modified Tardieu, Motricity Index, interventional goal assessment scales for lower limb muscle groups from upper limb. Conclusion: It was concluded that botulinum toxin A has a definite effect on the impairment and focal disability within a rehabilitation setup of selected patients with focal spasticity.
Effect of botulinum toxin type-A in patients with focal spasticity
Northern Clinics of Istanbul, 2015
OBJECTIVE: To investigate the effect of botulinum toxin type-A (BTX-A) on spasticity and function in patients with focal spasticity. METHODS: Patients attended to the outpatient clinic of physical medicine and rehabilitation department with a diagnosis of focal spasticity and had BTX-A injections because of spasticty were evaluated for the study. Demographic data, exercise status, orthoses, drugs used for spasticity, functional status, stages of spasticity of muscles before and after 1 st and 3 rd months of BTX-A injection according to Modified Ashworth Scale (MAS) were evaluated retrospectively. MedCalc 11.6 statistical program was used for statistical analyses. Statistical significance was defined as p<0.05. RESULTS: Forty-nine patients with focal spasticity were recruited for the study (35 men, 14 women). Mean age of the patients was 21.59±20.09 years. The patients had cerebral palsy (CP, n=28), 19 had hemiplegia (n=19) and paraplegia (n=2). Forty-three patients were using orthoses and exercising regularly. Mean Pediatric Functional Independence Measurement (WeeFIM) scores of the patients with CP was 54.82±28.91 and according to the Gross Motor Function Classification System (GMFCS) the patients were in stages 2 (14%), 3 (46%), 4 (11%) and 5 (29%). Mean Functional Independence Measure (FIM) of hemiplegic and paraplegic patients was 80.80±20.88. Brunnstrom staging scores for upper extremity (3.52±0.96), hands (2.68±0.82), lower extremity (4.57±1.01) were calculated. MAS muscles demonstrated statistically significant decrease in spasticity at the end of first and third months (p<0.05). CONCLUSION: We saw a significant decrease in the spasticity of upper and lower extremities in patients with focal spasiticity who received BTX-A injections. We suggest that if BTX-A injections are supported with orthoses and exercise programs, then functional status of the patients would be better.
Botulinum toxin A in the treatment of spasticity – An open label study
Journal of Back and Musculoskeletal Rehabilitation, 2002
To assess the efficacy of botulinum toxin type A in spasticity in upper-motor neuron syndromes. Methods: Twenty-three patients with spasticity resulted from stroke-related hemiplegia, transverse myelitis and multiple sclerosis took part in the study. Following the history and physical examinations of the patients, injections of botulinum toxin-A were applied. The dose ranged from 80 to 400 mouse unit (MU) depending on the size of the muscle injected. In all patients, spasticity, spasms and pain were measured using the Ashworth Scale, Spasm Frequency Score, and Visual Analogue Scale prior to the therapy, at the 1st week, 1st month and 3rd month of the therapy. Results: In all patients, botulinum toxin type A led to a significant decrease in spasticity, spasms and pain after the 1st week, 1st and 3 rd months of the treatment when compared to the baseline values (p < 0.001). No significant side effects or complications were observed. Conclusion: Our results have demonstrated that botulinum toxin type A is effective in the management of patients with spasticity due to stroke-related hemiplegia, transverse myelitis and multiple sclerosis, without major adverse effects.
The use of botulinum toxin therapy for lower-extremity spasticity in children with cerebral palsy
Neurosurgical FOCUS, 2006
EREBRAL palsy is the most common motor disorder in children, occurring in 2 to 2.5 per 1000 live births. It is the result of abnormal development of or injury to both gray and white matter within the central nervous system. Most children with CP experience hypertonia with components of spasticity and dystonia. This mixed hypertonicity limits muscle movement around a joint, interferes with voluntary motor movement, and decreases longitudinal muscle growth. As a result, CP commonly interferes with functional mobility, positioning, and self-care.
Journal of Rehabilitation Medicine, 2006
Objective: Analysis of the effects of a comprehensive focal spasticity program in adult patients. Design: Retrospective study of an out-patient cohort. Patients: One hundred patients were enrolled in the study (54 men and 46 women, mean age 41 years (SD 14). Cerebral palsy and stroke were equally common (80% in total). The remaining patients had miscellaneous diagnoses, including traumatic brain injury. Methods: On average 230 units (SD 101) of botulinum toxin A Botox † was given for 227 principal therapy targets chosen by the patient or the caregiver. One patient could have several targets for therapy. Administration of botulinum toxin was combined with 260 additional therapeutic interventions, most of which were forms of physical therapy. The effects were assessed after 6 weeks and compared with baseline functional abilities 1 Á /2 weeks prior to therapy.
Botulinum Toxin for Spasticity in Children With Cerebral Palsy: A Comprehensive Evaluation
PEDIATRICS, 2007
BACKGROUND-Spasticity is a prevalent disabling clinical symptom for children with cerebral palsy. Treatment of spasticity with botulinum toxin in children with cerebral palsy was first reported in 1993. Botulinum toxin provides a focal, controlled muscle weakness with reduction in spasticity. Interpretation of the literature is difficult due to the paucity of reliable measures of spasticity and challenges with measuring meaningful functional changes in children with disabilities.