Background and Purpose —We sought to define an effective and safe dose of botulinum toxin type A (Dysport) for the treatment of upper limb muscle spasticity due to stroke. Methods —This was a prospective, randomized, double-blind, placebo-controlled, dose-ranging study. Patients received either a placebo or 1 of 3 doses of Dysport (500, 1000, 1500 U) into 5 muscles of the affected arm. Efficacy was assessed periodically by the Modified Ashworth Scale and a battery of functional outcome measures. Results —Eighty-three patients were recruited, and 82 completed the study. The 4 study groups were comparable at baseline with respect to their demographic characteristics and severity of spasticity. All doses of Dysport studied showed a significant reduction from baseline of muscle tone compared with placebo. However, the effect on functional disability was not statistically significant and was best at a dose of 1000 U. There were no statistically significant differences between the groups in the incidence of adverse events. Conclusions —The present study suggests that treatment with Dysport reduces muscle tone in patients with poststroke upper limb spasticity. Treatment was effective at doses of Dysport of 500, 1000, and 1500 U. The optimal dose for treatment of patients with residual voluntary movements in the upper limb appears to be 1000 U. Dysport is safe in the doses used in this study.

German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.

No abstract

Close cooperation between occupational health services and CPRM appears to be necessary to speed the return to work by stroke patients.

DECAY M EASU RE M EN TS I N EM ULS ION ON PARTI CLES the nucleus may have been sufficient to cause (PvXy. )observed tO he OPPOStte tO (PZXPv)at production. This would have tended to mask any effect that might have been present. ACKNOW'LED GMENTSWe wish to express our appreciation and indebtedness: To Dr. Joseph J. Murray and his co11eagues for providing the separated E-meson beams, and to Dr. Edward J. Lofgren and the Bevatron crew for their cooperation and aid in the exposures. participation in the design and assembly of the equipment for magnetic analysis of beams, and for their help in various phases of the analyses.To all the scanners involved in this program and particula, rly to Miss Ernestine Beleal, Alan 8etz, Mrs. Marilyn O'I ollin, Mrs. Penny Vedder, and Mrs. Hester Yee for considerable assistance with the measurements and calculations.To i4Irs. Penny Vedder for much of the programming and aid with the IBM 650 computations.To James Hodges for constructing, and participating in the design of, the automated microscopes, and to Thomas Taussig for designing the associated electronics.A beam of Xs mesons was produced by passing a beam of 1.1-Bev/c negative pions through a liquid hydrogen target and accepting the neutral reaction products in the forward direction after allowing the X& component to decay. The resultant beam was observed in a 30-in. propane bubble chamber 6tted with lead and iron plates. About 200 regenerated IC1 mesons were identi6ed by their characteristic Q value and decay rate. All three types of regeneration were observed: by transmission in the plates, by nuclear di8raction, and by interaction with single nucleons. The detection of the erst two types of regeneration constitutes strong evidence for the correctness of the Gell-Mann and Pais particle mixture theory. Comparison of the transmission and diffraction regeneration e8ect, using the method of M. L. Good, gives the E~-Xg mass difference B. Two important corrections must be applied to Good's formula: One originates from the nuclear scattering of the transmission component, the other from the multiplicity of scatterings in a thick plate.The independence from nuclear parameters, which was an advantageous property of Good's formula, is no longer rigorously valid; but due to the sharp dependence of the transmission intensity upon the mass difference, the nuclear properties of Eo and Xo, as derived from E'+ and X data, still allow a measurement, of 8. We find that 5 is 0.84 s, ss+'ss in units of k/rip where rr is the Er mean lifetime. With 90% confidence level, the diiference is between 0.44 and 1.2 k/rr. The probability that the transmission peak we observe is due to a statistical fluctuation is one in a million.

Self-reported adverse events following botulinum toxin injections in spasticity are rare, often benign and of short duration in current clinical practice. Botulinum toxin is considered effective by patients in treating spasticity of the upper and lower limbs.

No abstract

Botulinum toxin (BTA) is a safe and effective therapeutic tool for many neurological conditions but few studies have investigated its real cost in neurological practice. We evaluated the daily cost of botulinum toxin type A (BTA) treatment through a cost effectiveness analysis alongside a prospective study of BTA injections at a French University Hospital over a 2-year follow-up period. The data of 3,108 BTA injections performed in 870 adult patients presenting with dystonia, facial hemispasm, or spasticity were entered in the database. Patients were questioned at each visit about the subjective effectiveness of the previous injection. The daily cost of BTA treatment was calculated as the ratio of each session's cost (including all additional costs) to the duration of subjective efficacy. The subjective rating of efficacy duration was 17.3 ± 7.7 weeks for facial hemispasm, 15.4 ± 7.7 for blepharospasm, 14.3 ± 6.7 for cervical dystonia, 14.5 ± 7.8 and 14.1 ± 7.4 weeks for upper and lower limb spasticity, respectively. The daily cost of BTA injections was 0.57 ± 0.20 for facial hemispasm, 0.95 ± 0.30 for blepharospasm, 2.85 ± 0.86 for cervical dystonia, 3.38 ± 1.49 and 3.62 ± 1.81 for upper and lower limb spasticity, respectively. When associated costs were considered, the daily cost of BTA injections was clearly increased (45-93%) in limb spasticity or rigidity but remained only modestly increased (15-37%) in other indications. These results obtained in a large cohort of patients show that BTA treatment has a low daily cost for a long-lasting effect, with a daily cost/benefit ratio that greatly depends on the indications.