title: Is spastic muscle echo intensity related to the response to botulinum toxin type A in patients with stroke? A cohort study.
abstract: OBJECTIVE
  To investigate the relationship between gastrocnemius muscle echo intensity and response to botulinum toxin type A (BoNT-A) in patients with spastic equinus foot resulting from stroke.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Adult patients (N=56) with spastic equinus foot resulting from stroke scheduled to receive BoNT-A injection into the gastrocnemius muscle.
  
  
  METHODS
  All patients were injected with BoNT-A (abobotulinumtoxinA) into the gastrocnemius muscle with an ultrasonography-guided, multisite injection technique. The toxin dose was 250U for the gastrocnemius medialis and 250U for the gastrocnemius lateralis (dilution 500U/2mL) in each patient. All patients were evaluated before and 4 weeks after BoNT-A injection.
  
  
  METHODS
  Spastic gastrocnemius muscle echo intensity visually graded with the Heckmatt scale. Clinical assessment of the spastic gastrocnemius with the Modified Ashworth Scale, Tardieu Scale, and ankle passive range of motion.
  
  
  RESULTS
  Postintervention testing at 4 weeks showed overall significant improvements in the clinical assessment of the spastic gastrocnemius muscle. No significant change was observed in the echo muscle intensity of the spastic gastrocnemius after BoNT-A injection. Post hoc comparisons showed that all clinical outcomes were significantly better in those patients with echo muscle intensity of the spastic gastrocnemius graded II on the Heckmatt scale than those with grades III (P<.001) and IV (P<.001) after botulinum toxin injection.
  
  
  CONCLUSIONS
  These findings support the hypothesis that patients with higher spastic muscle echo intensity have a reduced response to BoNT-A.
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Picelli
authors.forename: Paola
authors.initials: P
authors.lastname: Bonetti
authors.forename: Carla
authors.initials: C
authors.lastname: Fontana
authors.forename: Martina
authors.initials: M
authors.lastname: Barausse
authors.forename: Francesca
authors.initials: F
authors.lastname: Dambruoso
authors.forename: Francesca
authors.initials: F
authors.lastname: Gajofatto
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
authors.forename: Mario
authors.initials: M
authors.lastname: Manca
authors.forename: Raffaele
authors.initials: R
authors.lastname: Gimigliano
authors.forename: Nicola
authors.initials: N
authors.lastname: Smania
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D015331:Cohort Studies; D016001:Confidence Intervals; D004863:Equinus Deformity / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000187:drug effects*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA