Short-term electrical stimulation enhances the effectiveness of Botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients

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

doi:10.1016/0304-3940(94)12124-9

Cited by 160 publications

(114 citation statements)

References 8 publications

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“…3 This also explains why physiotherapy helps. 5 Electrical stimulation can also reduce spastic tone, [6][7][8] but has not yet been introduced in the clinic as standard therapy due to its various side effects. Recently, two groups showed that repetitive magnetic stimulation has positive effects on spastic tone increase.…”

Section: Introductionmentioning

confidence: 99%

Lumbar repetitive magnetic stimulation reduces spastic tone increase of the lower limbs

Krause¹,

Edrich²,

Straube³

2004

Spinal Cord

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Study Design: Comparison of spinal lesion subjects and normal subjects. Objective: To investigate the effects of a paravertebral repetitive magnetic stimulation on spastic tone increase of the lower limbs. Setting: Munich, Germany. Methods: We compared the effects in 15 patients with different spinal lesions and in 16 healthy subjects. The spastic tone increase was evaluated clinically with the Ashworth scale and apparatively with the pendulum test, both at fixed times before and after stimulation. Unilateral stimulation was applied to the lumbar nerve roots L3 and L4 of the clinically more spastic leg. Results: The spastic tone decreased significantly in the interval between 4 and 24 h after stimulation. This effect was slightly more pronounced in the contralateral extremity. Furthermore, the stimulation motor threshold of the patients was significantly raised. Conclusion: Repetitive magnetic unilateral stimulation has a positive effect on spastic tone increase due to spinal lesions, causing a decrease that lasts for about 1 day not only on the ipsilateral but also on the contralateral side.

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Section: Introductionmentioning

confidence: 99%

Lumbar repetitive magnetic stimulation reduces spastic tone increase of the lower limbs

Krause¹,

Edrich²,

Straube³

2004

Spinal Cord

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“…Hesse et al 57 have combined 2000 U of BTX (Dysport) with electrical stimulation of tibialis anterior and plantar flexor muscles in an attempt to enhance toxin effect. The combined treatment has been found to be superior with respect to the clinically assessed reduction of muscle tone, gait velocity, stride length, stance and swing symmetry.…”

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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“…Muscle contraction has been shown to increase the effect of the botulinum A toxin in rat phrenic nerve-diaphragm preparations 15 and in spastic human muscles that contract with electrical stimulation. [16][17][18] Alternately, it could be hypothesized that this same "pumping" action could extrude some of the injected toxin from the muscle into the paraglottic space, in which case it would be ineffective.…”

Section: Introductionmentioning

confidence: 99%

Vocal Exercise versus Voice Rest following Botulinum Toxin Injections: A Randomized Crossover Trial

Paniello¹,

Edgar²,

Perlmutter³

2010

Ann Otol Rhinol Laryngol

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Objectives-The intensity of muscle activity immediately following intramuscular botulinum toxin injection may affect the clinical efficacy of the injection. We tested this effect in patients who underwent botulinum toxin injections for adductor spasmodic dysphonia.Methods-Patients were studied over 3 to 5 injection cycles. Cycle 1 was the baseline control; cycle 2 was randomized between a 1-hour reading aloud task ("exercise") and a 24-hour period of complete voice rest. For cycle 3, the patient completed the task not performed in cycle 2. Patients who were willing to continue for cycles 4 and 5 repeated the experiment at one half the injection dosage. Efficacy was determined with a battery of voice recordings and clinical outcomes instruments administered via telephone at 2-to 4-week intervals. The primary outcome measure was the result of the Voice-Related Quality of Life (VRQOL) instrument.Results-Nine patients (8 women, 1 man) with a mean age of 60.8 years (range, 42 to 76 years) completed at least 3 injection cycles. The VRQOL results were significantly higher for cycles that followed the exercise task. The patients reported subjectively that these were some of the best injection cycles they had ever experienced. Some achieved equivalent results with the half-dose injection plus exercise. The VRQOL results after voice rest cycles were not significantly different from the patients' baseline cycles.Conclusions-These results support the conclusion that a period of intense vocalization immediately following laryngeal botulinum toxin injections improves the efficacy of the injection. Possible mechanisms are proposed.

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Short-term electrical stimulation enhances the effectiveness of Botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients

Cited by 160 publications

References 8 publications

Lumbar repetitive magnetic stimulation reduces spastic tone increase of the lower limbs

Lumbar repetitive magnetic stimulation reduces spastic tone increase of the lower limbs

Botulinum Toxin in Poststroke Spasticity

Vocal Exercise versus Voice Rest following Botulinum Toxin Injections: A Randomized Crossover Trial

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