title: Care management of spasticity with botulinum toxin-A in patients with severe acquired brain injury: a 1-year follow-up prospective study.
abstract: OBJECTIVE
  To evaluate the efficacy and the safety of repeated botulinum toxin type A (BT-A) injections in patients with severe acquired brain injury (ABI) and to gain a better knowledge of possible clinical or demographic characteristics associated with a better rehabilitation outcome.
  
  
  METHODS
  Prospective study with a 1-year follow-up period.
  
  
  METHODS
  Twenty-one patients with spasticity due to severe ABI and no further improving with rehabilitation treatment and oral anti-spastic drugs.
  
  
  METHODS
  Repeated BT-A injections associated to a rehabilitation programme.
  
  
  METHODS
  Barthel Index (BI), Modified Ashworth Score (MAS) and VAS score for pain subjective perception were recorded.
  
  
  RESULTS
  At the end of the follow-up study, MAS, BI and VAS significantly improved. Despite the number of BT-A injections, a shorter interval between severe ABI onset and first BT-A treatment correlated to a better BI improvement. None of the patients experienced adverse events attributable to BT-A.
  
  
  CONCLUSIONS
  BT-A was effective and safe in the treatment of spasticity in severe ABI patients, with a better functional outcome in those subjects treated earlier after spasticity onset. The lack of correlation between clinical outcome and number of injections suggests, in addition to a direct inhibition at the neuromuscular junction, a more distant BT-A long-term effect.
authors.affiliation: I.R.C.C.S. Fondazione 'Santa Lucia', Post-Coma Unit, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Clemenzi
authors.forename: Rita
authors.initials: R
authors.lastname: Formisano
authors.forename: Maria
authors.initials: M
authors.lastname: Matteis
authors.forename: Luciano
authors.initials: L
authors.lastname: Gallinacci
authors.forename: Giulio
authors.initials: G
authors.lastname: Cochi
authors.forename: Paola
authors.initials: P
authors.lastname: Savina
authors.forename: Paola
authors.initials: P
authors.lastname: Cicinelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A