Ankle Muscle Activity Before and After Botulinum Toxin Therapy for Lower Limb Extensor Spasticity in Chronic Hemiparetic Patients

Hesse, Stefan; Krajnik, J; Luecke, D.; Jahnke, M.T.; Gregorič, M; Mauritz, Karl Heinz

doi:10.1161/01.str.27.3.455

Cited by 156 publications

(87 citation statements)

References 12 publications

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“…Over the last few years, it has been used to treat spasticity in upper and lower limbs in both adults and children [7, 8, 9, 10, 11, 12, 13, 14]. Although these studies have demonstrated a significant improvement in muscle tone, functional benefit has been less consistently demonstrated [15].…”

Section: Introductionmentioning

confidence: 99%

A Double-Blind Randomised Placebo-Controlled Evaluation of Three Doses of Botulinum Toxin Type A (Dysport<sup>®</sup>) in the Treatment of Spastic Equinovarus Deformity after Stroke

Pittock¹,

Moore²,

Hardiman³

et al. 2003

Cerebrovasc Dis

182

173

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Background/Objectives: Calf muscle hypertonicity following stroke may impair walking rehabilitation. The aim of this study was to assess botulinum toxin (Dysport^®) in post-stroke calf spasticity. Methods: A prospective, multicentre, double-blind, placebo-controlled, dose-ranging study was performed to evaluate dysport at 500, 1,000 or 1,500 units in 234 stroke patients. They were assessed at 4-week intervals over 12 weeks. Results: The primary outcome measure, 2-min walking distance and stepping rate increased significantly in each group (p < 0.05, paired test), but there was no significant difference between groups (including placebo). Following dysport treatment, there were small but significant (p = 0.0002–0.0188) improvements in calf spasticity, limb pain, and a reduction in the use of walking aids, compared to placebo. Investigators’ and patients’ assessments of overall benefit suggested an advantage for dysport over placebo, but this was not significant. Sixty-eight patients reported 130 adverse events, with similar numbers in each group. The few severe events recorded were not considered to be treatment-related. Conclusion: Dysport resulted in a significant reduction in muscle tone, limb pain and dependence on walking aids. The greatest benefits were in patients receiving dysport 1,500 units, but 1,000 units also had significant effects. Dysport 500 units resulted in some improvements. Since few adverse events were reported, this therapy is considered safe and may be a useful treatment in post-stroke rehabilitation of the leg. Possible reasons why functional improvements in gait parameters were not observed are also discussed.

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Section: Introductionmentioning

confidence: 99%

A Double-Blind Randomised Placebo-Controlled Evaluation of Three Doses of Botulinum Toxin Type A (Dysport<sup>®</sup>) in the Treatment of Spastic Equinovarus Deformity after Stroke

Pittock¹,

Moore²,

Hardiman³

et al. 2003

Cerebrovasc Dis

182

173

View full text Add to dashboard Cite

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“…Also, it was recommended for the reduction of tone by the 2008 American Academy of Neurology (AAN) Practice Parameter [46]. An established procedure for drop foot is to inject into the gastrocnemius/soleus and/or tibialis posterior [11,46,[53][54][55][56][57][58][59]. This has been proposed as helpful in preventing "pistoning" out of the brace, improving forward tibial progression in stance, preventing skin breakdown, and reducing pain.…”

Section: Botulinum Toxinmentioning

confidence: 99%

“…Hesse and colleagues examined 12 subjects with chronic spastic hemiplegia from stroke [56]. All subjects were injected with BTA (onabotulinumtoxinA).…”

Section: Botulinum Toxinmentioning

confidence: 99%

Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot

Wilkenfeld¹

2013

JRRD

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Abstract-Spastic drop foot is a functional impairment causing significant morbidity and mortality. Multiple treatments are available for this condition, but it is often not clear which treatment or combination of treatments is optimal for a given patient. One relatively recent therapy is the use of functional electrical stimulation to stimulate the peroneal nerve. Another is the use of botulinum toxin injections in the spastic ankle plantar flexors. While reasons exist to think these two treatments might work effectively in combination, there is no clear consensus in the literature. In this article, I review the background of the pathophysiology of spastic drop foot and its treatment options. I present some of the theoretical reasons why functional electrical stimulation and botulinum toxin injections could work synergistically and present a literature review on the topic. Recommendations for future research are discussed.Key words: ankle, botulinum toxins, chemodenervation, drop foot, functional electrical stimulation, gait, muscle spasticity, neurorehabilitation, peroneal nerve stimulation, upper motor neuron syndrome. SPASTIC DROP FOOTSpastic drop foot is a functional impairment causing significant morbidity by impairing gait, limiting activities of daily living, and contributing to injuries [1]. Spastic drop foot exists when, due to a combination of weakness of the ankle dorsiflexors (primarily tibialis anterior) and spasticity of the ankle plantar flexors (primarily gastrocnemius and soleus), the ankle has a predisposition for staying pathologically plantar flexed. Due to associated weakness of ankle evertors (e.g., peroneal musculature) and/or spasticity of invertors (e.g., tibialis posterior), pathological foot inversion is also often associated [2][3].Because ankle dorsiflexion during the swing phase of gait is essential for foot clearance, drop foot can lead to falls and injury [1]. In addition, with drop foot, foot-floor contact in stance phase can happen initially at the forefoot (as opposed to at the heel in nondisabled gait) and limited dorsiflexion can prevent forward progression of the tibia, resulting in hyperextension of the knee and limited forward translation of the body [4]. Those affected often develop pathological compensatory gaits to attempt to compensate for spastic drop foot. One of these, referred to as "steppage gait," involves abnormally flexing the hip and bending the knee to attempt to get the foot to clear the ground [5]. Other patients will hike their hip on the side of the spastic ankle with each swing phase or circumduct the lower limb to aid in foot clearance [6].Abbreviations: AAN = American Academy of Neurology, AFO = ankle-foot orthosis, BTA = botulinum toxin type A, BTB = botulinum toxin type B, BTX = botulinum toxin, CMAP = compound muscle action potential, CNS = central nervous system, FES = functional electrical stimulation, MS = multiple sclerosis, PNS = peroneal nerve stimulation, SCI = spinal cord injury, TBI = traumatic brain injury, UMNS = upper motor neuron syndro...

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“…Subsequently, Hesse et al 55 injected 400 U of BTX (Botox) to the spastic calf muscles of 12 patients and has been able to show statistically significant improvement in gait analysis parameters, including velocity, stride length and stance symmetry. In another study with a similar number of patients and injected muscles, Hesse et al 56 have investigated the effect of BTX on ankle muscle activity using dynamic electromyography. While correlation has been observed between muscle tone reduction and gait parameters, significant improvements have also been reported for walking speed, stride length and premature activity of soleus muscle after injection.…”

Section: Btx For Lower Limb Spasticitymentioning

confidence: 99%

Botulinum Toxin in Poststroke Spasticity

Özçakır

Sivrioğlu²

2007

Clinical Medicine & Research

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Poststroke hemiparesis, together with abnormal muscle tone, is a major cause of morbidity and disability. Although most hemiparetic patients are able to reach different ambulatory levels with rehabilitation efforts, upper and lower limb spasticity can impede activities of daily living, personal hygiene, ambulation and, in some cases, functional improvement.The goals of spasticity management include increasing mobility and range of motion, attaining better hygiene, improving splint wear and other functional activities. Conservative measures, such as positioning, stretching and exercise are essential in spasticity management, but alone often are inadequate to effectively control it. Oral antispastic medications often provide limited effects with short duration and frequent unwanted systemic side effects, such as weakness, sedation and dry mouth.Therefore, neuromuscular blockade by local injections have become the first choice for the treatment of focal spasticity, particularly in stroke patients. Botulinum toxin (BTX), being one of the most potent biological toxins, acts by blocking neuromuscular transmission via inhibiting acetylcholine release. Currently, focal spasticity is being treated successfully with BTX via injecting in the spastic muscles.Two antigenically distinct serotypes of BTX are available on the market as type A and B. Clinical studies of BTX used for spastic hemiplegic patients are reviewed in this article in two major categories, upper and lower limb applications. This review addresses efficacy in terms of outcome measures, such as muscle tone reduction and functional outcome, as well as safety issues. Application modifications of dose, dilutions, site of injections and combination therapies with BTX injections are also discussed.

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Ankle Muscle Activity Before and After Botulinum Toxin Therapy for Lower Limb Extensor Spasticity in Chronic Hemiparetic Patients

Cited by 156 publications

References 12 publications

A Double-Blind Randomised Placebo-Controlled Evaluation of Three Doses of Botulinum Toxin Type A (Dysport<sup>®</sup>) in the Treatment of Spastic Equinovarus Deformity after Stroke

A Double-Blind Randomised Placebo-Controlled Evaluation of Three Doses of Botulinum Toxin Type A (Dysport<sup>®</sup>) in the Treatment of Spastic Equinovarus Deformity after Stroke

Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot

Botulinum Toxin in Poststroke Spasticity

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