title: Repeated botulinum toxin injections can improve mobility in patients with spinal cord lesions.
abstract: OBJECTIVE
  The aim of this study was to increase the knowledge about the response to botulinum toxin (BTX) injections to spastic leg muscle motor points (MP) in spinal cord lesion (SCL) patients, and describe improvement of mobility with repeated BTX injections.
  
  
  METHODS
  Six patients with ASIA grade C or D SCL were studied at the Loewenstein Rehabilitation Center, Israel. The main outcome measures were: modified Ashworth scale scores, range of motion (ROM), and mobility spinal cord independence measure (SCIM) scores. BTX was injected twice within a few weeks' interval to the MP of spastic leg muscles. The outcome measures were monitored before each injection and 2 weeks or more after the second injection.
  
  
  RESULTS
  Following the first BTX injection the tonus decreased, ROM increased in all 6 patients, and mo- bility functioning improved in 4 of them. Following the repeated injection the tonus further decrea- sed, ROM further improved in 5 of 6 patients, and mobility functions further improved in 4 of 6 patients.
  
  
  CONCLUSIONS
  BTX can improve mobility in patients with SCL. Repeated injections may enhance the effect despite the concern for resistance formation. Further research is needed to support the findings and determine the optimal BTX doses and intervals between injections.
authors.affiliation: Spinal Department and Research Laboratory, Loewenstein Rehabilitation Hospital, Raanana, Israel. amcatz@post.tau.ac.il
authors.forename: A
authors.initials: A
authors.lastname: Catz
authors.forename: H
authors.initials: H
authors.lastname: Barkol
authors.forename: F
authors.initials: F
authors.lastname: Steinberg
authors.forename: J
authors.initials: J
authors.lastname: Ronen
authors.forename: V
authors.initials: V
authors.lastname: Bluvshtein
authors.forename: O
authors.initials: O
authors.lastname: Keren
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002574:Cervical Vertebrae; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D016059:Range of Motion, Articular / Q000502:physiology; D013118:Spinal Cord Diseases / Q000150:complications*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A