Comparison of botulinum toxin injection and neurotomy in patients with distal lower limb spasticity.
OBJECTIVE
We compared the efficacy of botulinum toxin injection (BTI) and tibial nerve neurotomy (TNN) in an open-label study of 34 post-stroke hemiplegic patients with distal lower limb deformation.


METHODS
The dose of BT was 300 U (Botox). TNN was performed with a 6-12 month delay on the motor branches of the tibial nerve. Muscles to be treated were selected according to the distal deformity (equinus, varus and clawing toes). Patients were assessed following each treatment for spasticity, motor control, range of movements, balance, gait and the Rivermead Motor Assessment.


RESULTS
TNN (M3, M6 and Y1) resulted in a more significant effect than BTI (D15, M2 and M5) on most of the measures: ankle plantar flexor spasticity, range of movement in dorsiflexion and eversion, foot position in upright situation, Functional Ambulation Categories (barefoot), RMA, gait velocity (comfortable condition), subjective benefit and use of walking aids. Patients treated for tibialis posterior or flexor digitorum longus spasticity often complained of subjective sensory disorders at the plantar sole over a period of 4-6 weeks.


CONCLUSIONS
In conclusion, TNN is more effective than BTI on most of the functional parameters. The interest of BTI lies in the preliminary testing of the efficacy of a technique for reducing spasticity on lower limb function.
Rousseaux
M
M
Service de Rééducation Neurologique, Hôpital Swynghedauw, CHRU, Lille, France. mrousseaux@chru-lille.fr
Buisset
N
N
Daveluy
W
W
Kozlowski
O
O
Blond
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004341:Drug Evaluation; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000473:pathology*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D004856:Postural Balance / Q000187:drug effects; D016138:Walking / Q000502:physiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A