title: SBOTE study: extracorporeal shock wave therapy versus electrical stimulation after botulinum toxin type a injection for post-stroke spasticity-a prospective randomized trial.
abstract: Research is on-going to identify new methods of biostimulation to increase the effect of botulinum toxin type A (BTX-A) in the treatment of spasticity. The Spasticity treated by Botulinum Toxin and ESWT (SBOTE) study is a prospective, randomized controlled trial assessing the effectiveness of extracorporeal shock wave therapy (ESWT) given immediately after BTX-A injections compared with electrical stimulation (ES) given immediately after BTX-A therapy for the management of focal upper limb spasticity in stroke patients. ES was given for 30 min twice a day for 5 days starting at 5 Hz; ESWT was given once a day for 5 days. At study follow-up, patients treated with BTX-A injections and ESWT showed a statistically greater significance and continuous decrease of spasticity measure (modified Ashworth scale [MAS]: 1.37, 1.75 and 1.58 at 15, 30 and 90 days post-treatment, respectively), of spasms (spasm frequency scale [SFS]: 0.8 and 0.25 at 30 and 90 days post-treatment, respectively) and of pain (visual analogue scale [VAS]: 1.94 and 1.87 at 30 and 90 days, respectively) compared with patients treated with BTX-A injections and ES (MAS: 2.37, 2.18 and 2.18, respectively) (p < 0.05) (SFS: 1.5 and 1.06, respectively) (p < 0.05) (VAS: 2.44 and 2.69 respectively) (p < 0.05). ESWT enhances the effect of BTX-A to a greater extent than ES, probably by modulating rheology of the muscle and neurotransmission at the neuromuscular junction.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Foggia, Foggia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Santamato
authors.forename: Angela
authors.initials: A
authors.lastname: Notarnicola
authors.forename: Francesco
authors.initials: F
authors.lastname: Panza
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ranieri
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Micello
authors.forename: Paolo
authors.initials: P
authors.lastname: Manganotti
authors.forename: Biagio
authors.initials: B
authors.lastname: Moretti
authors.forename: Francesca
authors.initials: F
authors.lastname: Fortunato
authors.forename: Serena
authors.initials: S
authors.lastname: Filoni
authors.forename: Pietro
authors.initials: P
authors.lastname: Fiore
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D009465:Neuromuscular Agents / Q000008:administration & dosage; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A