Botulinum toxin type A for the treatment of arm and hand spasticity in stroke patients.
BACKGROUND
Focal spasticity can be a major drawback in the rehabilitation of stroke patients. Previous studies suggest a beneficial effect for botulinum toxin A (BTX-A) for relief of spasticity.


OBJECTIVE
To evaluate the safety and efficacy of BTX-A in the treatment of spasticity in a homogeneous group of stroke patients.


METHODS
In this phase III open label trial 19 stroke patients stable for at least six months were enrolled (mean age 53.1 (SD 3.27) years; range 26-72). There were 16 males and 4 females.


METHODS
Clinical (Ashworth spasticity rating scale, scores for joint mobility, pain and frequency of spasms, Frenchay arm test (FAT)) and subjective (semi-quantitative rating scale filled out by the patient). Only hand and finger flexors were injected. The maximum dosage was 150 U BOTOX (25 U/muscle), the mean dosage was 92.1 +/- 31.6 U BOTOX.


RESULTS
Ashworth rating scale and joint mobility scores improved from a median value of 2 at baseline to a median value of 1 one month after treatment, FAT scores also improved from a median value of 0 at baseline to a median value of 1 one month after treatment (Kruskall-Wallis test p < 0.01). Two-thirds of the patients rated their functional improvement as none or mild.


CONCLUSIONS
Our study confirmed that BTX-A has an anti-spastic effect but its functional impact needs further evaluation.
Sampaio
C
C
Department of Pharmacology and Therapeutics, Hospital de Santa Maria, Lisbon.
Ferreira
J J
JJ
Pinto
A A
AA
Crespo
M
M
Ferro
J M
JM
Castro-Caldas
A
A
D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000534:rehabilitation; D005260:Female; D006225:Hand / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D009128:Muscle Spasticity / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D014953:Wrist / Q000502:physiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A