title: Botulinum toxin in severe upper extremity spasticity among patients with traumatic brain injury: an open-labeled trial.
abstract: We studied the effect of botulinum toxin A (BTXA) among patients with traumatic brain injury (TBI) and severe spasticity unresponsive to conservative management. Twenty-one consecutive adult patients with severe spasticity involving the wrist and finger flexor musculature were treated with BTXA injection (20 to 40 units per muscle) under EMG guidance. After injection, patients received passive range of motion (ROM) exercise, with modalities and casting as clinically indicated. Outcome measures, including wrist ROM and the modified Ashworth Scale (MAS), were assessed 2 to 4 weeks after injection. Among the respective acute and chronic groups, mean ROM improved 42.9 (p = 0.001) and 36.2 degrees (p < 0.001). Mean MAS rating improved 1.5 (p = 0.01) and 1.47 (p = 0.002) points. There were no significant adverse effects. BTXA, in conjunction with conventional modalities, significantly improves spasticity and ROM in the distal upper extremity musculature of patients with TBI.
authors.affiliation: Brain Injury Program, Institute for Rehabilitation and Research, Houston, TX, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Yablon
authors.forename: B T
authors.initials: BT
authors.lastname: Agana
authors.forename: C B
authors.initials: CB
authors.lastname: Ivanhoe
authors.forename: C
authors.initials: C
authors.lastname: Boake
mesh_terms: D000328:Adult; D001905:Botulinum Toxins / Q000627:therapeutic use*; D001930:Brain Injuries / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D001905:Botulinum Toxins