A prospective, multicentre, randomized, double-blind, placebo-controlled trial of onabotulinumtoxinA to treat plantarflexor/invertor overactivity after stroke

Dunne, John W.; Graciès, Jean-Michel; Hayes, Michael; Zeman, Brian; Singer, Barbara

doi:10.1177/0269215511432016

Cited by 53 publications

(51 citation statements)

References 31 publications

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“…It is defined as the inability to dorsiflex the foot beyond the plantigrade level, or neutral. This nonoperative management is often supplemented by treatment aimed at reducing spasticity that can be effectively achieved by a course of botulinum toxin injection to the spastic muscle [13,14]. The midfoot and forefoot are in neutral alignment in equinus deformity.…”

Section: Equinus Deformitymentioning

confidence: 99%

Foot deformities in children with cerebral palsy

Kedem

Scher²

2015

Current Opinion in Pediatrics

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Foot deformities are common among children with cerebral palsy. The three most common among them are equinus, planovalgus and equinovarus/equinocavovarus. Treatment consists of orthotics, physical therapy, spasticity reduction treatment and surgical correction. Guidelines for treatment are individualized and multifactorial. Important considerations include the child's level of function, the severity and flexibility of the deformity, the presence or absence of pain and skin irritation, and the changes in alignment observed over time.

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Section: Equinus Deformitymentioning

confidence: 99%

Foot deformities in children with cerebral palsy

Kedem

Scher²

2015

Current Opinion in Pediatrics

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“…BTX-A is also used as an analgesic in migraine, diabetic neuropathic pain, and complex regional pain syndrome (27,28). Dunne et al (29) injected BTX-A (200 or 300 U) into the lower extremities of 85 patients and found a significant decrease in spasticity and pain at the end of 12 weeks. In another study, 500 U BTX-A was injected into the pectoralis major muscle of post-stroke patients for the treatment of spastic shoulder pain and the improvement in pain lasted for 6 months (30).…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of Botulinum Toxin Injection Effect for Poststroke Spasticity Treatment

Demiryürek¹,

Gündoğdu²

2017

tnd

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Amaç: Bu çalışmada, inme sonrası üst ya da alt ekstremite spastisitesi gelişen hastaların tedavisinde Botulinum toksin-tip A (BTX-A) enjeksiyonunun spastisite ve spastisiteye bağlı ağrı tedavisindeki etkinliği ile günlük yaşam aktivitelerine olan etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem:Bu çalışmaya inme sonrası üst ekstremite ya da alt ekstremitede spastisite nedenli 249±41 U BTX-A uygulanmış 35 (23 sağ taraf, 12 sol taraf) hasta alındı. Üst ekstremitede dirsek, el bileği ve parmaklarda, alt ekstremitede ise bacak, diz ve ayak bileğinde spastisite derecesi; BTX-A enjeksiyonu öncesi, işlem sonrası 1. ay ve işlem sonrası 3. ay Modifiye Ashworth Skalası (MAS) ile değerlendirildi. Ayrıca BTX-A işlemi öncesi, işlem sonrası 1. ay ve işlem sonrası 3. ay günlük yaşam aktiviteleri Barthel indeksi ile, spastisiteye bağlı ağrı ise Vizüel Analog Skalası (VAS) ile değerlendirildi. Bulgular: Çalışmaya alınan hastaların yaş ortalaması 60±6 idi. Hastaların %69'unda üst ve alt ekstremite, %31'inde ise üst ya da alt ekstremite etkilenmişti. MAS, VAS ve Barthel indeksi kullanılarak BTX-A'nın tedavi öncesine göre anlamlı olarak spastisite ve ağrı şiddetinde azalma, fonksiyonellikte ve yaşam kalitesinde ise artma sağladığı sonucuna varıldı. Birinci ayda sağlanan faydanın 3. ay takiplerinde de sürdüğü saptandı.Sonuç: İnmeye bağlı spastisite tedavisinde BTX-A uygulanması yan etki açısından güvenli, hastaların ağrısını azaltan, fonksiyonelliği ve yaşam kalitesini artıran, uzun süreli etkinlik sağlayabilen bir yöntemdir.Anahtar Kelimeler: İnme, spastisite, botulinum toksin, ağrıObjective: In this study we aimed to evaluate the effectivity of treatment with the botulinum toxin-type A (BTX-A) on spasticity, spasticity-related pain, and the daily living activities in post-stroke patients with upper or lower limb spasticity. Materials and Methods:A total of 35 (23 right side, 12 left side) post-stroke patients who had upper and/or lower limb spasticity were enrolled to the study. BTX-A (249±41 U) was applied to their affected extremities. The degree of spasticity in the upper (elbow, wrists, and fingers) and lower (leg, knee and ankle) extremities was evaluated before treatment, 1 month, and 3 months after treatment using Modified Ashworth Scale (MAS). Daily life activities and severity of spasticity-related pain were also evaluated using the Barthel index and Visual Analogue Scale (VAS) at the same time points. Results:The average age of the patients in the study was 60±6 years. Both upper and lower extremities were affected in 69%, whereas upper or lower extremities were affected in 31% of patients. BTX-A provided improvement in severity of the spasticity, pain scale, functionality, and quality of life according to the MAS, VAS, and Barthel indexes.The benefits were sustained in the first 3 months of the post-treatment.Conclusion: BTX-A in the treatment of post-stroke spasticity is a reliable method in terms of adverse effects, pain reduction, its ability to provide long-term effectiveness, and increase functionality an...

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“…BoNT has been shown to be effective at decreasing muscle tone in all [54,[66][67][68][69] but one study [70]. Similarly, two studies found improvement in pain [69,70] and increasing range of motion [54,67], respectively, but others found no difference between treatment and placebo groups in measures of pain [67] and range of motion [69] in adults with lower extremity spasticity.…”

Section: Adult Spasticity In the Lower Extremitiesmentioning

confidence: 98%

“…Similarly, two studies found improvement in pain [69,70] and increasing range of motion [54,67], respectively, but others found no difference between treatment and placebo groups in measures of pain [67] and range of motion [69] in adults with lower extremity spasticity. The only study assessing active joint movement, spasm frequency and gait quality found a significant benefit in participants treated with BoNT as opposed to those receiving placebo.…”

Section: Adult Spasticity In the Lower Extremitiesmentioning

confidence: 99%

Botulinum Toxin for Neuropathic Pain and Spasticity: An Overview

2014

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In recent years, a large body of data has surfaced reporting the therapeutic benefit of botulinum toxin injection in multiple conditions. The aim of this review is: to summarize the highest quality literature pertaining to clinical application of botulinum toxin in neuropathic pain conditions including postherpetic neuralgia, trigeminal neuralgia, diabetic polyneuropathy, post-traumatic neuralgia, carpal tunnel syndrome, complex regional pain syndrome, phantom limb and stump pain, and occipital neuralgia; to provide an overview of the clinical trials using botulinum toxin in adult spasticity; and to assign levels of evidence according to the American Academy of Neurology guidelines. In summary, there is level A evidence for established efficacy in postherpetic neuralgia and adult spasticity; level B evidence for probable efficacy in trigeminal neuralgia and post-traumatic neuralgia; level B evidence for probable lack of efficacy in carpal tunnel syndrome; level C evidence for possible efficacy in diabetic polyneuropathy; and level U (insufficient) evidence in complex regional pain syndrome, phantom limb and stump pain, and occipital neuralgia.

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A prospective, multicentre, randomized, double-blind, placebo-controlled trial of onabotulinumtoxinA to treat plantarflexor/invertor overactivity after stroke

Cited by 53 publications

References 31 publications

Foot deformities in children with cerebral palsy

Foot deformities in children with cerebral palsy

The Evaluation of Botulinum Toxin Injection Effect for Poststroke Spasticity Treatment

Botulinum Toxin for Neuropathic Pain and Spasticity: An Overview

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