Effects of botulinum toxin type A for spastic foot in post-stroke patients enrolled in a rehabilitation program

Abstract

The objective of this study was to evaluate the effects of botulinum toxin type A (BTX-A) on spastic foot in stroke patients in a rehabilitation program. Method: Hemiparetic stroke patients (n=21) enrolled in a rehabilitation program were divided into two groups. The first group (n=11) received a total of 300UI BTX-A, and the second group (n=10) received 100 UI BTX-A. All patients were assessed at baseline and 2, 4, 8 and 12 weeks after injection for Modified Ashworth Score, time walking 10 meters, and the Functional Independence Measure (mFIM) motor score. Results: The higher-dose group exhibited a significant improvement in spasticity, and both groups showed an improvement in time walking 10 meters and mFIM, with no significant differences between them. Conclusions: Our findings suggest that gains in gait velocity and functional independence were not correlated to BTX-A dose.Keywords: botulinum toxin type A, stroke, spasticity. RESUMOO objetivo deste estudo foi avaliar os efeitos da toxina botulínica tipo A (TXB-A) sobre a espasticidade de membro inferior em pacientes pós-AVE em reabilitação. Método: 21 pacientes hemiparéticos foram divididos em dois grupos que receberam doses de TXB-A de 300UI (Grupo 1) e 100UI (Grupo 2) e foram avaliados antes da injeção e 2, 4, 8 e 12 semanas após, quanto à escala de Ashworth modificada, tempo para andar 10 metros e escore motor da Medida de Independência Funcional (MIFm). Resultados: O grupo que utilizou dose mais alta teve melhora significativa da espasticidade. Ambos os grupos tiveram melhora do tempo para andar 10 metros e da MIFm sem diferença significativa entre eles. Conclusões: A melhora da velocidade de marcha e da independência funcional não foram correlacionadas com a dose de TXB-A na amostra analisada.Palavras-chave: toxina botulínica tipo A, acidente vascular cerebral, espasticidade.

Botulinum Toxin Therapy Combined with Rehabilitation for Stroke: A Systematic Review of Effect on Motor Function

“…Twenty-six studies were reviewed, including 1307 patients. There was a significant effect observed in 23 studies in the intervention group on spasticity [18][19][20][21][22][24][25][26][27][28][29][30][31][32][34][35][36][37][40][41][42][43][44][45]. In regard to upper limb motor function, 11 of 14 cases showed improvement, but two studies showed significant differences in comparison with the control group [19][20][21]25,[27][28][29][30][31][32][33][34]37,42,45].…”

“…In regard to upper limb motor function, 11 of 14 cases showed improvement, but two studies showed significant differences in comparison with the control group [19][20][21]25,[27][28][29][30][31][32][33][34]37,42,45]. In regard to lower extremity motor function, 12 of 14 cases showed improvement, and seven studies showed a significant difference in comparison to the control group [18,19,[22][23][24][25][26]35,36,[38][39][40][41]43,44].…”

“…Uchiyama et al (2018) used Group 1 as BoNT-A combined with physical therapy (PT) and occupation therapy (OT), and Group 2 used the first phase as rehabilitation only and the second phase as BoNT-A combined with PT and OT [18]. Pimentel et al (2014) compared BoNT-A doses at 300 and 1000 U [26]. Lim et al (2008) administered BoNT-A for shoulder pain and spasticity and compared it to triamcinolone acetonide [33].…”

“…Pennati et al (2015) indicated improvement in upper limb function in both groups, but both the FMA and Box and Block test showed better improvement in the control group (rehabilitation only) [42]. In three of 14 studies, there was no significant improvement by intervention [26,27,30,31]. In particular, Demetrios et al (2014) mentioned that there were no significant differences in change scores for the assessment of upper limbs [25].…”

“…Johnson et al (2002Johnson et al ( , 2004 reported that the physiological cost index (PCI) decreased slightly in the intervention group with improvement in lower extremity function, which was not observed in the control group (rehabilitation only) [38,39]. Though five studies showed improvement in motor function by intervention, there was no significant difference compared with control group or there was no comparison between groups [18,19,26,35,40]. Interestingly, Burbaud et al (1996) focused not only on changes in lower limb motor function but also on changes in aids.…”