Gait improvement by low-dose botulinum toxin A injection treatment of the lower limbs in subacute stroke patients

Abstract

[Purpose] Lower-limb spasticity after stroke may be associated with worse functional outcome. Our study aim was to establish whether a low-dose botulinum toxin A (BTX-A) injection in subacute stroke patients can improve spasticity, gait, and daily living abilities. [Subjects] Twenty-three subacute stroke patients were randomly allocated to BTX-A treatment group (11 patients) and control group (12 patients). [Methods] In the BTX-A treatment group patients, 200 units BTX-A was injected into the triceps surae (150 iu) and posterior tibial (50 iu) by electrical stimulation-guided. The patients in the control group received the same volume of placebo solution into the same injection locations. Gait analysis (step length, cadence, speed), the 6-min walking test, Fugl-Meyer Assessment (FMA) of the lower limbs, modified Ashworth scale assess (MAS) assessment of the lower limbs, surface electromyography (sEMG), and modified Barthel index (MBI) assessment were performed before and at 4,8 weeks after treatment. [Results] We found that the FMA of the low limbs and MBI were significantly improved in both groups. The gait analysis, FMA, and MBI results in the BTX-A treatment group were better than those in the control group. MAS and surface electromyography (sEMG) showed better improvement of spasticity in the treatment group. [Conclusion] Early low-dose botulinum toxin A (BTX-A) injection in subacute stroke patients into the lower-limb may improve gait, spasticity, and daily living abilities.

OnabotulinumtoxinA for the Treatment of Poststroke Distal Lower Limb Spasticity: A Randomized Trial

“…These effects were sustained and further improved during the open‐label extension. These findings support the outcomes reported by others after single doses of onabotulinumtoxinA [14], even in patients with less severe spasticity (MAS ≥1) than the patients included in this study [15,16]. A corresponding significant improvement in a key secondary endpoint, CGI as assessed by physician (average of weeks 4 and 6), was reported for the onabotulinumtoxinA group (versus placebo); also supporting the outcomes reported by others [14].…”

An international survey of patients living with spasticity

“…This in contrast to recent studies in post-stroke patients indicating potential benefits of very early intervention (injection within 6 weeks-3 months). [20][21][22] Limitations of this study are those inherent to patient surveys, which are based on the patient's own understanding of their condition, and are not compared with objective clinical information (e.g. about symptom severity, or response to treatment).…”

Rehabilitation of Patients With Post-Stroke Spasticityof the Lower Limb at an Early Restorative Period

“…Результаты 10-метрового теста, анализ видеоматериалов констатируют значительно лучшие пока-затели скорости ходьбы и характера походки в группе пациентов, получавших ботулотоксин в составе комплекс-ной реабилитации, что согласуется с данными междуна-родных исследований [10, 18-20, 22, 23]. Результаты работ по раннему включению ботулинического нейротоксина в программу реабилитации в ранний восстановительный период после перенесенного инсульта для лечения спа-стичности нижней конечности показывают, что включение ботулотоксина в период формирования спастичности в небольших дозах дает возможность повлиять на функцио-нальный исход и качество жизни пациентов [17,24,28,29]. Важно отметить, что в группе, получавшей ботулинический нейротоксин для лечения спастичности нижней конечно-сти с раннего восстановительного периода после инсульта, возросло число пациентов, способных к самостоятельному передвижению, без помощи посторонних лиц и дополни-тельных средств опоры.…”

“…В настоящее время исследования по лечению спа-стичности нижней конечности проводятся с большей выборкой пациентов, и вектор науки сместился в сторону изучения влияния инъекций ботулинического нейроток-сина на улучшение активной функции конечности и каче-ство жизни пациентов [22][23][24]. Также в последние годы проводилось изучение эффективности и безопасности больших доз ботулинического токсина для пациентов с гемиспастичностью [25,26].…”