title: Post-stroke spasticity management with repeated botulinum toxin injections in the upper limb.
abstract: OBJECTIVE
  Although the botulinum toxin A (BTX-A) treatment has proved effective in spasticity management, no information is available with regard to the effects of repeated injections over time.
  
  
  METHODS
  To evaluate the effects of BTX-A on moderate or severe upper limb spasticity, an exploratory investigation was performed on 28 stroke patients treated for 2 yr or longer and observed for 3 yr. Every 3 to 5 mo, each patient received BTX-A injections in upper limb muscles. The assessment, performed before and 1 mo after each injection for a median of 28 mo, included technical and functional objectives and the burden of care. The former were evaluated by using the modified Ashworth Scale for spasticity and the goniometric measurement of rest position and range of motion; functional objectives were evaluated by means of the Frenchay Arm Test and a patient/caregiver goals assessment scale.
  
  
  RESULTS
  BTX-A treatment was followed by an improvement in all technical outcome measures. Motor dexterity scores improved in only 8 of 28 patients, vs. daily living activities, which increased in all subjects. Although the average dosage injected per session did not change, intervals between injections became longer. No relationship between either spasticity onset or residual motoricity and response to treatment could be found.
  
  
  CONCLUSIONS
  This investigation is relevant clinically because repeated BTX-A injections show unchanging effectiveness in the management of focal spasticity after stroke.
authors.affiliation: Clinic of Neurorehabilitation, University of Ancona, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Lagalla
authors.forename: M
authors.initials: M
authors.lastname: Danni
authors.forename: F
authors.initials: F
authors.lastname: Reiter
authors.forename: M G
authors.initials: MG
authors.lastname: Ceravolo
authors.forename: L
authors.initials: L
authors.lastname: Provinciali
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001132:Arm; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A