Cortical somatosensory processing after botulinum toxin therapy in post-stroke spasticity

Abstract

In dystonic and spastic movement disorders, abnormalities of motor control and somatosensory processing as well as cortical modulations associated with clinical improvement after botulinum toxin A (BoNT-A) treatment have been reported, but electrophysiological evidence remains controversial. In the present observational study, we aimed to uncover central correlates of post-stroke spasticity (PSS) and BoNT-A-related changes in the sensorimotor cortex by investigating the cortical components of somatosensory evoked potentials (SEPs). Thirty-one chronic stroke patients with PSS of the upper limb were treated with BoNT-A application into the affected muscles and physiotherapy. Clinical and electrophysiological evaluations were performed just before BoNT-A application (W0), then 4 weeks (W4) and 11 weeks (W11) later. PSS was evaluated with the modified Ashworth scale (MAS). Median nerve SEPs were examined in both upper limbs with subsequent statistical analysis of the peak-to-peak amplitudes of precentral P22/N30 and postcentral N20/P23 components. At baseline (W0), postcentral SEPs were significantly lower over the affected cortex. At follow up, cortical SEPs did not show any significant changes attributable to BoNT-A and/or physiotherapy, despite clear clinical improvement. Our results imply that conventional SEPs are of limited value in evaluating cortical changes after BoNT-A treatment and further studies are needed to elucidate its central actions.

Blepharospasm Patients after Botulinum Toxin – Sleep Approach

“…It is possible that this central action can influence sleep characteristics and quality of life in these patients. 13,14 Although there are no studies in the literature on actigraphy or circadian rhythm related to dystonia, the main limitations of the present study were the small sample size and a lack of polysomnography. A few more studies must be done to explain the impact of botulinum toxin in the sleep of patients with this kind of dystonia.…”

“…It is possible that this central action can influence sleep characteristics and quality of life in these patients. 13 14 …”

O Benefício Da Toxina Botulínica Na Reabilitação Fisioterapeutica Pós Acidente Vascular Encefálico Associado a Kinesiotaping®: Revisão De Literatura

“…No estudo observacional feito por Veverka et al (2021), o tratamento com a toxina botulínica associado a fisioterapia com técnicas de cinesioterapia em pacientes pós AVE no primeiro estágio crônico da doença, reduziu significativamente a espasticidade do membro superior na Semana 4 (p<0,0001) com aumentos subsequentes na Semana 11 (p=0,013), embora a redução na Semana 0 permaneceu significativo (p = 0,0001).…”

Comprehensive rehabilitation of patients with post-stroke upper limb dysfunction: a randomized controlled trial

“…Сегодня специфическим методом лечения фокальной или мультифокальной спастичности, имеющим высокий уровень рекомендаций (А) и класс доказательности (I), является ботулинотерапия (БТ), представляющая собой регулярные инъекции ботулинического токсина типа А (БТА) в мышцы, формирующие индивидуальный спастический паттерн. Обоснованность и целесообразность включения БТ в комплекс реабилитационных программ, направленных на снижение спастичности и восстановление тонкой манипулятивной активности верхней конечности, подтверждена рядом исследований последних лет [25][26][27][28][29][30][31][32][33][34][35].…”