[Post stroke hemiplegia: interest of botulinum toxin injection at the upper limb].
OBJECTIVE
To present data about the effect of botulinum toxin injection on the upper limb of stroke patients.


METHODS
We used the Medline data bank. Analysis took into account the international classification of functioning and disability. Important technical or pragmatic points were analysed separately.


RESULTS
Botulinum toxin reduces spasticity of the injected muscles, with a mean gain of about 1 point on the Ashworth scale in the 4 to 6 weeks post injection, but with a large variability. This is associated to an increase in the passive range of motion, especially at wrist, and at times to a facilitation of active movements, when they are still possible. Improvement in functional tests is observed when fair proximal and distal motricity persists. Reduction in the dependence in daily living activities has not been shown by group studies. Several patients have an improvement in using the hand for blocking and transporting objects, mainly in a facilitating position (pronation, partial wrist flexion). Comfort of patients and caregivers is more regularly improved. Results are partially predictable; improvement in function is observed in patients with fair distal motricity (extension) and low spasticity, and improvement in comfort in those with severe spasticity and low motricity.


CONCLUSIONS
Further studies are required, on one hand for better assessment of distal functional improvement, on the other hand at earlier phases of the disease.
Rousseaux
M
M
Service de rééducation neurologique, hôpital Swynghedauw, CHU, 59037 Lille cedex, France. mrousseaux@chru-lille.fr
Launay
M J
MJ
Kozlowski
O
O
D000203:Activities of Daily Living; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000494:pharmacology*; D006225:Hand / Q000502:physiology; D006429:Hemiplegia / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins