Botulinum toxin treatment for lower limb extensor spasticity in chronic hemiparetic patients.

Hesse, Stefan; Lücke, D; Malezic, M; Bertelt, Christine; Friedrich, H; Gregorič, M; Mauritz, Karl-Heinz

doi:10.1136/jnnp.57.11.1321

Cited by 157 publications

(81 citation statements)

References 13 publications

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“…Most of the research has been conducted in stroke. Double-blinded placebo-controlled trials have shown it to be safe and effective in the management of spasticity in both the upper limb 1,2 and the lower limb 3,4 . Studies in multiple sclerosis 5,6 have demonstrated functional benefits in the management of hip adductor spasticity.…”

Section: What Is the Evidence That Btx Work?mentioning

confidence: 99%

Botulinum toxin in the management of spasticity in adults

Turner-Stokes

Ward²

2002

Clinical Medicine

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-Botulinum toxin (BTX) is a powerful neurotoxin which blocks cholinergic transmission at the neuromuscular junction. Judiciously applied, it can reduce local muscle overactivity while maintaining the strength in other muscles. To date BTX has not been licensed for use in spasticity in the UK and the literature pertaining to clinical practice is still relatively scant. However, controlled trials have provided evidence of the effectiveness of BTX both in reducing spasticity itself and in achieving functional gain. The guidance given here to clinicians involved in the management of spasticity covers the types of patient suitable for treatment using BTX, the appropriate dosage, and the necessary follow-up procedures and documentation.

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Section: What Is the Evidence That Btx Work?mentioning

confidence: 99%

Botulinum toxin in the management of spasticity in adults

Turner-Stokes

Ward²

2002

Clinical Medicine

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“…Previous open trial studies have reported substantial amelioration in the muscle tone of spastic patients, both in the upper9 11-13 and lower limbs. '0 [13][14][15][16][17][18][19] To confirm the apparent effectiveness of BTX, double blind, placebo controlled studies have been called for, 20 21 and this we set out to do in a population of adult hemiparetic patients with ankle plantar flexor and foot invertor spasticity.…”

mentioning

confidence: 99%

A randomised, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients.

Burbaud

Wiart

Dubos

et al. 1996

Journal of Neurology, Neurosurgery & Psychiatry

216

163

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Objective-To confirm the apparent effectiveness of botulinum toxin (BTX) in hemiparetic patients with ankle plantar flexor and foot invertor spasticity. Methods-Twenty three hemiparetic patients with spasticity of the ankle plantar flexors and foot invertors were included in a randomised double blind, placebo controlled study with BTX. Patients were examined on days 0, 30, 90, and 120 and received one injection of BTX and one of placebo in a random order at day 0 and day 90. Results-Patients reported a clear subjective improvement in foot spasticity after BTX (P = 0-0014) but not after placebo. Significant changes were noted in Ashworth scale values for ankle extensors (P < 0.0001) and invertors (P = 0.0002), and for active ankle dorsiflexion (P = 0-0001). Gait velocity was slightly but not significantly (P = 0-0731) improved after BTX injections. The severity of spasticity did not modify treatment efficacy, but BTX was less effective in patients with longer duration of spasticity (P = 0-0081). Conclusion-The efficacy of BTX injections in the treatment of spastic foot suggests that BTX may be particularly useful during the first year after a stroke.

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“…There are 7 antigenically distinct serotypes that inhibit the neuronal release of acetylcholine, producing functional denervation of muscle fibers. 4 Botulinum toxins appear to be useful in the treatment of focal spasticity, 28,29 although additional studies in this area are warranted.…”

Section: Discussionmentioning

confidence: 99%

Open-Label Dose-Titration Safety and Efficacy Study of Tizanidine Hydrochloride in the Treatment of Spasticity Associated With Chronic Stroke

Gelber

Good

Dromerick

et al. 2001

Stroke

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Background and Purpose-Spasticity is a frequently observed motor impairment that develops after stroke; it can cause pain and disability in those affected. The objective of the present study was to evaluate the safety and efficacy of tizanidine, a centrally acting ␣ 2 -adrenergic agonist, in the treatment of stroke-related spasticity. Methods-Forty-seven patients, who were a minimum of 6 months poststroke and had significant spasticity, were studied at 4 centers.Tizanidine was administered in an open-label manner for 16 weeks, beginning at 2 mg/d and slowly titrated to a maximum of 36 mg/d. The Modified Ashworth Scale, muscle strength testing, functional assessments, and Pain and Functional Spasticity Questionnaires were administered at baseline and at 4, 8, 16, and 18 weeks (after 1 week off tizanidine). Results-Spasticity was significantly improved between baseline and week 16, with a decrease in total upper extremity Modified Ashworth Scale score of 2.80Ϯ0.47 (PϽ0.0001). No decline in strength was noted. Treatment with tizanidine resulted in a significant improvement in pain intensity (Pϭ0.0375), quality of life (Pϭ0.0001), and physician assessment of disability (Pϭ0.0001). The most frequent side effects were somnolence (62%) and dizziness (32%). No serious adverse events were considered to be drug related. Ten of 47 patients (21%) were able to reach the maximum daily dosage of 36 mg. Conclusions-Overall, the data suggest that tizanidine is safe and efficacious in the treatment of stroke-related spasticity, preserving muscle strength while reducing muscle tone and painful spasms in affected patients.

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Botulinum toxin treatment for lower limb extensor spasticity in chronic hemiparetic patients.

Cited by 157 publications

References 13 publications

Botulinum toxin in the management of spasticity in adults

Botulinum toxin in the management of spasticity in adults

A randomised, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients.

Open-Label Dose-Titration Safety and Efficacy Study of Tizanidine Hydrochloride in the Treatment of Spasticity Associated With Chronic Stroke

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