Botulinum toxin in post-stroke patients: stiffness modifications and clinical implications.
OBJECTIVE
To objectively quantify stiffness and clinical changes in the upper limb of poststroke patients following botulinum toxin (BT) injection.


METHODS
Eighteen consecutive chronic post-stroke spastic patients were injected Botulinum toxin A in the forearm flexor spastic muscles. Spasticity was clinically evaluated with the Ashworth scale. Stiffness was measured with indices (passive stiffness index (ISI) and total stiffness index (TSI) obtained by mechanical wrist displacements induced by a torque motor,which could also provide the stretch reflex threshold speed (SRTS) from flexor muscles. Functional status was measured with the Barthel index and a specific hand ability scale, pain with a visual analogue scale (VAS). The ranges of voluntary wrist extension (EROM) and flexion (FROM) and wrist isometric extension and flexion (IE-IF) strength were also calculated.


RESULTS
IE and EROM significantly increased, being respectively p < 0.01 and p < 0.05; also SRTS was augmented (p < 0.001),while TSI showed lower values (p < 0.001); the Ashworth score decreased at least one point. Hand function for selected tasks improved in 50% of patients, the Barthel index only in 4 (22 %), forearm pain was completely relieved in 3 patients (17 %).


CONCLUSIONS
BT can be considered a valid therapeutic tool in all spastic patients, because of immediate advantages: reduction of muscle hypertonia, pain relief, improvement in selected motor performances.
Department of Neurology, Istituto Auxologico Italiano, IRCCS, Strada L. Cadorna 90, 28824, Piancavallo Oggebbio (VB), Italy. gmiscio@auxologico.it
Giacinta
G
Miscio
Carmen
C
Del Conte
Danilo
D
Pianca
Roberto
R
Colombo
Marcela
M
Panizza
Marco
M
Schieppati
Fabrizio
F
Pisano
D000328:Adult; D000368:Aged; D001132:Arm / Q000294:innervation / Q000503:physiopathology*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000294:innervation / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000187:drug effects / Q000502:physiology; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D012026:Reflex, Stretch / Q000187:drug effects / Q000502:physiology; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome; D014953:Wrist / Q000503:physiopathology
D001905:Botulinum Toxins