Combined effects of botulinum toxin and casting treatments on lower limb spasticity after stroke.
Optimal treatment of spasticity requires a combination of pharmacotherapy and muscle lengthening. We evaluated 13 stroke patients with equinovarus foot randomized to treatment with either botulinum toxin A (BTA) injection plus ankle-foot casting (n=6) or BTA alone (n=7). The tibialis posterior and calf muscles (range of BTA injection: 190 to 320 U) were treated in each patient. Castings were worn at night for four months. Each patient was examined before, and at two and four months after BTA injection using the static and dynamic baropodometric tests, the Modified Ashworth Scale and the 10-meter walking test. At two months, therapeutic effects were observed in both groups. At four months, the study group showed further clinical improvement, while the control group returned to baseline performance. Thus, prolonged stretching of spastic muscles after BTA injection affords long-lasting therapeutic benefit, enhancing the effects of the toxin alone.
Farina
Simona
S
Department of Neurology and Vision Science, University of Verona, Italy. simonfar@tiscali.it
Migliorini
Claudia
C
Gandolfi
Marialuisa
M
Bertolasi
L
L
Casarotto
Matteo
M
Manganotti
Paolo
P
Fiaschi
Antonio
A
Smania
Nicola
N
D000368:Aged; D000704:Analysis of Variance; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003025:Clubfoot / Q000209:etiology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D016037:Single-Blind Method; D013165:Splints; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A