A randomized controlled trial of botulinum toxin on lower limb spasticity following acute acquired severe brain injury

Verplancke, D; Snape, Sue; Salisbury, C; Jones, Peter W.; Ward, Anthony B.

doi:10.1191/0269215505cr827oa

Cited by 105 publications

(68 citation statements)

References 19 publications

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“…In this review, we evaluated the outcome in upper limb joints and found that clinical improvement is more consistent for distal joints. A similar evaluation was not performed for the lower limb, as only one study on the lower limb spasticity could be included based on our strict criteria 27 ; the other available trials were excluded because the patients were also treated with casts, 17 or they did not all have post-stroke spasticity, 18 or the data were incomplete. 19 The results of the lower limb spasticity study included showed no significant improvement in walking or spasticity 27 following injection in the gastrocnemius muscle.…”

Section: Discussionmentioning

confidence: 99%

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Botulinum neurotoxins for post‐stroke spasticity in adults: A systematic review

et al. 2009

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The aim of this systematic review was to determine whether botulinum neurotoxin (BoNT) reduce spasticity or improve function in adult patients after stroke. Eleven double-blind randomized placebo-controlled trials met inclusion criteria. They encompassed 782 patients, 767 (98%) of whom received BoNT/A, and 15 (2%) BoNT/B. Most studies used the Ashworth scale as primary outcome measure. Differences between treated and control groups were assessed as categorical or continuous comparisons. The overall effect on upper limb spasticity was in favor of BoNT/A. A significantly higher number of patients had a reduction of upper limb spasticity at 4-week and 8-week evaluations in the treatment group compared with placebo. Mean changes in joint spasticity revealed improvement 3 to 6 weeks and 9 to 12 weeks after treatment. There were insufficient data to establish BoNT/A efficacy on lower limb spasticity or the effect of BoNT/B on the upper and lower limbs. Because of inconsistency and heterogeneity of the available data, it was not possible to perform a meta-analysis on disability and patients' reported outcomes. There was an overlapping safety profile between the treatment and the placebo groups. BoNT/ A reduces upper limb spasticity in patients post-stroke, but the improvement in functional ability remains to be established. This gap needs to be filled by new studies to assess the effect of BoNT in the context of multidisciplinary patient management.2009 Movement Disorder Society

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Section: Discussionmentioning

confidence: 99%

“…Five studies were excluded because participants were treated with phenol block 15,16 or casts, 17 because not all patients had post-stroke spasticity, 18 or because the data were incomplete. 19 Two trials were reported both as full length publication and as abstract.…”

Section: Findings Description Of Studiesmentioning

confidence: 99%

Botulinum neurotoxins for post‐stroke spasticity in adults: A systematic review

et al. 2009

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“…The slow progress and the deterioration in right-knee ROM in the first 2 months after admission prompted the move to a more aggressive stretch programme. Serial casting [27][28][29][30] for the right knee therefore began. A series of five casts was applied over 5 weeks.…”

Section: Interventionmentioning

confidence: 99%

An Intensive Programme of Passive Stretch and Motor Training to Manage Severe Knee Contractures after Traumatic Brain Injury: A Case Report

Leung

Harvey

Moseley

2013

Physiotherapy Canada

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Purpose: While contemporary management of contractures (a common secondary problem of acquired brain injury that can be difficult to treat) includes passive stretch, recent evidence indicates that this intervention may not be effective. This may be because clinical trials have not provided a sufficient dose or have not combined passive stretch with other treatments. The purpose of this case report is to describe a programme of intensive passive stretch combined with motor training administered over a 1.5-year period to treat severe knee contractures. Method: Five months after traumatic brain injury, an adolescent client with severe contractures in multiple joints underwent an intensive stretch programme for his knee contractures, including serial casting and splinting, which was administered for 10 months in conjunction with a motor training programme administered for 1.5 years. Results: The client regained full extension range in his knees and progressed from being totally dependent to walking short distances with assistance; these effects were maintained at follow-up 5.5 years after injury. Conclusion: The use of a high dose of passive stretch in conjunction with motor training may be an option to consider for correcting severe contractures following acquired brain injury.Key Words: brain injuries; contracture; exercise therapy; muscle stretching exercises. RÉ SUMÉObjectif : Bien que le contrô le des contractures (un problè me secondaire fré quent propre aux lé sions cé ré brales acquises et pouvant ê tre difficile à traiter) comprenne des é tirements passifs, des preuves ré centes indiquent que cette intervention pourrait ê tre inefficace. Cela pourrait s'expliquer par le fait que les essais cliniques n'ont pas utilisé des dosages suffisants ou qu'ils n'ont pas jumelé les é tirements passifs à d'autres traitements. L'objectif de ce rapport de cas consiste à dé crire un programme d'é tirements passifs intensifs allié à un entraînement moteur administré durant une pé riode d'un an et demi pour le traitement de contractures sé vè res au genou. Mé thodologie : Cinq mois aprè s un traumatisme cé ré bral, un client adolescent aux prises avec des contractures sé vè res à de multiples articulations a é té soumis à un programme intensif d'é tirements pour ses contractures au genou, y compris l'application successive de plâ tres et d'attelles. Le programme a é té administré pendant 10 mois, en mê me temps qu'un programme d'entraînement moteur qui a duré un an et demi. Ré sultats : Le client a retrouvé la pleine extension de son genou et ses progrè s se sont é tendus d'une dé pendance totale à la capacité de marcher sur de courtes distances sans aide; ces effets se sont prolongé s pendant un suivi de cinq ans et demi aprè s le traumatisme. Conclusion : L'utilisation des é tirements passifs à dosage é levé en mê me temps qu'un entraînement moteur pourrait ê tre une avenue à considé rer pour corriger les contractures sé vè res ré sultant d'un traumatisme cé ré bral.Contractures-a reduction in passive joint range d...

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“…There are more than 10,000 interesting articles and the relevant papers published every week all over the world contain much more information than the average human brain can assimilate. Even the most recent part of the literature dealing with the impact and safety of botulinum toxin in clinical applications is rather enormous, including short [4], extended [5], classical [6] and new [7,8,9,10,11] articles. An additional difficulty originates from the fact that the research field is spread over a wide range of various and frequently not very much related disciplines such as biochemistry, bioterrorism, chemical synthesis, cosmetics, ecology, medicine, microbiology, neurology.…”

Section: Introductionmentioning

confidence: 99%

Botulinum Neurotoxin: The Ugly Duckling

Koussoulakos¹

2009

Eur Neurol

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This review presents a brief account of the most significant biological effects and clinical applications of botulinum neurotoxins, in a way comprehensive even for casual readers who are not familiar with the subject. The most toxic known substances in botulinum neurotoxins are polypeptides naturally synthesized by bacteria of the genus Clostridium. These polypeptides inhibit acetylcholine release at neuromuscular junctions, thus causing muscle paralysis involving both somatic and autonomic innervation. There is substantial evidence that this muscle-paralyzing feature of botulinum neurotoxins is useful for their beneficial influence on more than 50 pathological conditions such as spastic paralysis, cerebral palsy, focal dystonia, essential tremor, headache, incontinence and a variety of cosmetic interventions. Injection of adequate quantities of botulinum toxins in spastic muscles is considered as a highly hopeful procedure for the treatment of people who suffer from dystonia, cerebral palsy or have experienced a stroke. So far, numerous and reliable studies have established the safety and efficacy of botulinum neurotoxins and advocate wider clinical therapeutic and cosmetic applications.

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A randomized controlled trial of botulinum toxin on lower limb spasticity following acute acquired severe brain injury

Abstract: Active intervention with casting prevents talipes equinovarus deformities in patients losing ankle movement following severe brain injury. Casting alone in these patients is sufficient; the role of additional botulinum toxin needs further investigation, but is safe in these patients.

Cited by 105 publications

References 19 publications

Botulinum neurotoxins for post‐stroke spasticity in adults: A systematic review

Botulinum neurotoxins for post‐stroke spasticity in adults: A systematic review

An Intensive Programme of Passive Stretch and Motor Training to Manage Severe Knee Contractures after Traumatic Brain Injury: A Case Report

Botulinum Neurotoxin: The Ugly Duckling

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