Focal spasticity therapy with botulinum toxin: effects on function, activities of daily living and pain in 100 adult patients.
OBJECTIVE
Analysis of the effects of a comprehensive focal spasticity program in adult patients.


METHODS
Retrospective study of an out-patient cohort.


METHODS
One hundred patients were enrolled in the study (54 men and 46 women, mean age 41 years (SD 14). Cerebral palsy and stroke were equally common (80% in total). The remaining patients had miscellaneous diagnoses, including traumatic brain injury.


METHODS
On average 230 units (SD 101) of botulinum toxin A Botox was given for 227 principal therapy targets chosen by the patient or the caregiver. One patient could have several targets for therapy. Administration of botulinum toxin was combined with 260 additional therapeutic interventions, most of which were forms of physical therapy. The effects were assessed after 6 weeks and compared with baseline functional abilities 1-2 weeks prior to therapy.


RESULTS
Improvement was observed for 211 (93%) therapy targets, no change in 15 (7%), and impairment in 1, corresponding to an overall improvement in 90 patients (90%), 9 unchanged (9%) and worsening in 1. Spasticity assessment (Ashworth scale 0-4; 30 patients) showed a statistically significant improvement (median at baseline was 3 vs 2 after therapy, mean difference 1.2, p<0.001).


CONCLUSIONS
Improvement was observed in >or=90% of patients and in their principal therapeutic targets in a cohort receiving their first focal spasticity treatment with botulinum toxin A and additional therapy. A strict strategy for patient selection and comprehensive management was followed.
Bergfeldt
Ulla
U
Rehabilitation Medicine University Clinic, Karolinska Institutet, Stockholm, Sweden. ulla.bergfeldt@ds.se
Borg
Kristian
K
Kullander
Kjell
K
Julin
Per
P
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D001930:Brain Injuries / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation; D002547:Cerebral Palsy / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010045:Outpatients; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A