Somatosensory evoked potentials of hand muscles in stroke and their modification by botulinum toxin: a preliminary study.
OBJECTIVE
To determine the effect of botulinum toxin A on spasticity and somatosensory evoked potentials of hand muscles in patients who have undergone cerebrovascular accident.


METHODS
Preliminary, prospective, before-after study design.


METHODS
Six subjects prospectively followed after application of botulinum toxin A in the rehabilitation department of a university hospital.


METHODS
All patients underwent botulinum toxin A injection to the upper extremity muscles in varying combinations and carried out a home-based exercise programme. Primary outcome measure was median somatosensory evoked potential of hand muscles (N20). Secondary outcome measures were: spasticity assessed clinically by Modified Ashworth Scales (MAS); functional ability analysis assessed by Physician's Rating Scale (PRS); and functional difficulties reported by patients or their care-givers by patient disability and care-giver burden rating scale (PD & CBRS).


RESULTS
MAS, PRS and PD & CBRS improved with botulinum toxin A treatment. In the affected limb, N20 potentials were impaired compared with those in the unaffected side. With botulinum toxin A treatment, although improvement in overall N20-P25 amplitudes was significant, as a result of limited sample size, post hoc pair-wise comparisons with Bonferroni correction failed to yield any significant pairs.


CONCLUSIONS
The improvement in the median somatosensory evoked potentials following botulinum toxin A treatment suggests that central somatosensory patterns in hemiplegia can be modified by peripheral inputs.
Konya Beyhekim State Hospital, Physical Medicine and Rehabilitation Clinic, Yazir, Selcuklu TR-42250 Konya, Turkey. aynurbasaran@hotmail.com
Aynur
A
Basaran
Ufuk
U
Emre
Kiymet Ikbal
KI
Karadavut
Nercivan
N
Bulmus
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004185:Disability Evaluation; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects*; D005081:Exercise Therapy; D005260:Female; D006225:Hand; D006305:Health Status Indicators; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009470:Muscle Spindles / Q000187:drug effects; D018908:Muscle Weakness / Q000534:rehabilitation; D018482:Muscle, Skeletal / Q000187:drug effects*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D009609:Nitrous Oxide; D011434:Proprioception; D011446:Prospective Studies; D013035:Spasm / Q000188:drug therapy; D020521:Stroke / Q000188:drug therapy; D000071939:Stroke Rehabilitation; D013997:Time Factors; D034941:Upper Extremity
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; D009609:Nitrous Oxide