Effect of intrathecal baclofen, botulinum toxin type A and a rehabilitation programme on locomotor function after spinal cord injury: a case report.
OBJECTIVE
A few studies have reported the use of botulinum toxin injections after spinal cord injury, as this is the gold standard to treat focal spasticity. We report such a case here.


METHODS
A 38-year-old woman who had become paraplegic and care-dependent secondary to cervico-thoracic intramedullary ependymoma, presented 8 months later with painful lower limb spasticity, which was being treated with oral anti-spastic and benzodiazepine drugs with no therapeutic effect. We treated the patient with intrathecal baclofen to reduce her spasticity and in order to avoid the major side-effects of high dosages of oral baclofen. After motor rehabilitation programmes, which included functional electrical stimulation, the patient was able to wear an advanced reciprocating gait orthosis. However, she experienced painful muscle spasms in her toes of the feet that limited her gait. Therefore, she was also treated with bilateral injections of botulinum toxin type A into the flexor digitorum brevis muscles. The patient reported relief of spasms and pain, enabling her to wear an advanced reciprocating gait orthosis and facilitating rehabilitation programmes.


CONCLUSIONS
The use of botulinum toxin type A may be an important adjunctive therapy to increase the therapeutic effect of baclofen on spasticity in small muscles, resulting in a more focal effect, and improving the use of orthoses and the effectiveness of rehabilitation programmes in patients after spinal cord injury.
Santamato
Andrea
A
Department of Physical Medicine and Rehabilitation, University of Foggia, Foggia, Italy. a.santamato@unifg.it
Panza
Francesco
F
Ranieri
Maurizio
M
Amoruso
Maria Teresa
MT
Amoruso
Loredana
L
Frisardi
Vincenza
V
Solfrizzi
Vincenzo
V
Fiore
Pietro
P
D000328:Adult; D001418:Baclofen / Q000008:administration & dosage*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004806:Ependymoma / Q000150:complications; D005260:Female; D005684:Gait; D006801:Humans; D007273:Injections, Intramuscular; D007278:Injections, Spinal; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009128:Muscle Spasticity / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D013119:Spinal Cord Injuries / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D013125:Spinal Neoplasms / Q000150:complications; D016896:Treatment Outcome
D009125:Muscle Relaxants, Central; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; D001418:Baclofen