title: Combined effects of botulinum toxin and casting treatments on lower limb spasticity after stroke.
abstract: 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.
authors.affiliation: Department of Neurology and Vision Science, University of Verona, Italy. simonfar@tiscali.it
authors.forename: Simona
authors.initials: S
authors.lastname: Farina
authors.forename: Claudia
authors.initials: C
authors.lastname: Migliorini
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Gandolfi
authors.forename: L
authors.initials: L
authors.lastname: Bertolasi
authors.forename: Matteo
authors.initials: M
authors.lastname: Casarotto
authors.forename: Paolo
authors.initials: P
authors.lastname: Manganotti
authors.forename: Antonio
authors.initials: A
authors.lastname: Fiaschi
authors.forename: Nicola
authors.initials: N
authors.lastname: Smania
mesh_terms: 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
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A