title: Onabotulinumtoxin-A injection for disabling lower limb flexion in hemiplegic patients.
abstract: BACKGROUND
  Hemiplegic patients with supraspinal spasticity can present with a flexor pattern at the hip and knee that hampers both passive and active functions.
  
  
  OBJECTIVE
  To investigate the efficacy of OnabotulinumtoxinA injections on this flexor scheme.
  
  
  METHODS
  This open-label observational study included eleven patients who had suffered a unilateral stroke or traumatic brain injury. All had impairment in the activities of daily living caused by severe hip and knee flexion. OnabotulinumtoxinA injections of 300-400U (total dose) were administered to the iliopsoas (iliacus) and knee flexors and, when necessary, to other muscles of the hip and knee. Evaluations were performed pre-treatment (weeks -4 to -8, and day 1) and post-treatment (week 10 and week 21): spasticity, range of motion, limb positioning, passive functions and pain.
  
  
  RESULTS
  A modest improvement in hip and knee extension was observed, as evidenced by the Modified Ashworth Score and range of passive extension movements. Limb positioning was also improved. Clear benefits were found on passive functioning, including toileting, dressing and bed facilities, as well as pain levels. Active functions remained unchanged. More definite improvement was found in patients with severe difficulties.
  
  
  CONCLUSIONS
  OnabotulinumtoxinA injection can contribute to reducing the consequences of disabling lower limb flexion.
authors.affiliation: Neurological Rehabilitation Unit, Hôpital Swynghedauw, CHRU of Lille, Lille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Rousseaux
authors.affiliation: Neurological Rehabilitation Unit, Hôpital Swynghedauw, CHRU of Lille, Lille, France.
authors.forename: Walter
authors.initials: W
authors.lastname: Daveluy
authors.affiliation: Neurological Rehabilitation Unit, Hôpital Swynghedauw, CHRU of Lille, Lille, France.
authors.forename: Odile
authors.initials: O
authors.lastname: Kozlowski
authors.affiliation: Neurological Rehabilitation Unit, Hôpital Swynghedauw, CHRU of Lille, Lille, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Allart
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage*; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006429:Hemiplegia / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007273:Injections, Intramuscular; D035002:Lower Extremity / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin type-A; lower limb; muscle spasticity; onabotulinumtoxinA