Early Botulinum Toxin Type A Injection for Post-Stroke Spasticity: A Longitudinal Cohort Study

Abstract

Early management of spasticity may improve stroke outcome. Botulinum toxin type A (BoNT-A) is recommended treatment for post-stroke spasticity (PSS). However, it is usually administered in the chronic phase of stroke. Our aim was to determine whether the length of time between stroke onset and initial BoNT-A injection has an effect on outcomes after PSS treatment. This multicenter, longitudinal, cohort study included stroke patients (time since onset <12 months) with PSS who received BoNT-A for the first time according to routine practice. The main outcome was the modified Ashworth scale (MAS). Patients were evaluated before BoNT-A injection and then at 4, 12, and 24 weeks of follow-up. Eighty-three patients with PSS were enrolled. MAS showed a significant decrease in PSS at 4 and 12 weeks but not at 24 weeks after treatment. Among the patients with a time between stroke onset and BoNT-A injection >90 days, the MAS were higher at 4 and 12 weeks than at 24 weeks compared to those injected ≤90 days since stroke. Our findings suggest that BoNT-A treatment for PSS should be initiated within 3 months after stroke onset in order to obtain a greater reduction in muscle tone at 1 and 3 months afterwards.

Physicians’ Practice of the Non-Cosmetic Uses of Botulinum Toxin: A Cross-Sectional Study in Saudi Arabia

“…It has been reported in previous literature that delivery of injections without instrumental guidance was practiced in 25% of post-stroke spasticity cases [25]. Most importantly, late management of a significant number of post-stroke spasticity cases has been reported, which increases the likelihood of severe muscle hypertonia and contracture, emphasizing the importance of early planning of treatment for stroke survivors [26]. On the other hand, BTX injections have shown long-term prophylaxis of chronic migraine with good tolerability and improvement of quality of life in severe persistent cases by decreasing the incidence of depression and enhancing work productivity [27][28].…”

How Does Stroke Affect Skeletal Muscle? State of the Art and Rehabilitation Perspective

“…To avoid this potentially damaging effect, a tempestive treatment, integrated with early stretching treatment, could be a proper strategy. Indeed, even if BoNT-A injections are the gold standard in patients with spasticity in the chronic phase of stroke ( 44 ), recent studies showed that BoNT-A treatment performed within 3 months since stroke onset in naïve patients with spasticity can achieve the maximum effect on muscle tone, allowing better control of spasticity in chronic phase and a reduction of serial injections ( 45 – 47 ). Moreover, a careful systematic follow-up of treated patients is necessary ( 48 ).…”

Long-Term Spasticity Management in Post-Stroke Patients: Issues and Possible Actions—A Systematic Review with an Italian Expert Opinion

“…Italy, as well as other nations, does not have a consistent clinical care model for the treatment of post-stroke spasticity with BoNT-A and the routine use of botulinum toxin in clinics is far from standardized [ 17 ]. Notwithstanding a massive literature supporting the efficacy of BoNT-A for the treatment of PSS, there still are shortcomings in the routine management of PSS patients [ 18 , 19 , 20 , 21 , 22 , 23 ].…”