title: Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualised, flexible injection regimens.
abstract: Current antispastic medications are unsatisfactory for spasticity treatment, but botulinum toxin type A (BTX-A) shows promise as a new therapeutic option. This open-label, prospective study aimed to assess the effectiveness of BTX-A in improving functional mobility in the early post-stroke population using an individualised, flexible range of doses and targeted muscle groups. Twenty-one stroke patients (13 male, 8 female) were enrolled and injected with BTX-A (Botox, Allergan, mean dose: 255 U; range: 185-300) according to individual spasticity patterns. Assessments were made at baseline and weeks 2, 4, 6, 10 and 16 post-treatment. Outcome measures comprised: Modified Ashworth Scale (MAS), finger flexion scale (Bhakta), MRC scale, Physician's Rating Scale (PRS), Nine Hole Peg Test (9HPT), Motor Assessment Scale, Clinical Global Impression (CGI), Global Assessment of Spasticity (GASS) and Visual Analogue Scale (VAS) for pain assessment. Statistically significant improvements in muscle tone as determined by the MAS were found in all areas (except arm) till week 16 (p<0.05). Finger positioning improved for the study duration, whilst muscle power increased only slightly in specific muscles. PRS revealed significant improvements to week 10 and slight improvement in 9HPT performance in selected patients was observed. Motor Assessment Scale results were statistically significant for arm, hand and advanced hand functions, although the overall functional benefit was mild. GASS and CGI results also showed improvement. Pain was present only in 11 patients and did not significantly improve following treatment. Individualised BTX-A injection regimens may be an effective, reversible and safe new treatment option for patients with spasticity. Nevertheless, functional improvement may be reached only in selected patients.
authors.affiliation: Department of Neurosurgery, Division of Movement Disorders and Functional Neurosurgery, Medical University, ul. Debinki 7, 80-211, Gdansk, Poland. jaroslawek@amg.gda.pl
authors.forename: J
authors.initials: J
authors.lastname: Slawek
authors.forename: A
authors.initials: A
authors.lastname: Bogucki
authors.forename: D
authors.initials: D
authors.lastname: Reclawowicz
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D004185:Disability Evaluation; D004305:Dose-Response Relationship, Drug; D005260:Female; D005385:Fingers / Q000503:physiopathology; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D009129:Muscle Tonus / Q000187:drug effects / Q000502:physiology; D018482:Muscle, Skeletal / Q000187:drug effects / Q000294:innervation / Q000503:physiopathology; D009460:Neurologic Examination; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects; D010291:Paresis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A