Surgical Outcomes After Minimally Invasive Release of Stroke-Related Equinovarus Contracture of the Foot and Ankle

Boffeli, Troy J.; Collier, Rachel C.; Neubauer, Elizabeth F.; Malay, D. Scot

doi:10.1053/j.jfas.2019.01.019

Cited by 4 publications

(1 citation statement)

References 16 publications

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“…We observed a minor proportion of stroke patients discontinuing BoNT-A treatment for surgical management of spasticity (about 10%), although neuro-orthopedic surgery of upper limbs, and especially lower limbs, is well established [ 36 , 37 ]. The main reason for this is that in most cases, neuro-orthopedic surgery, which includes tendon lengthening, tendon releases, tendon transfers, and neurotomies [ 38 ], is performed at the level of the lower limb; the upper limb is still treated with BoNT-A.…”

Section: Discussionmentioning

confidence: 99%

Reasons and Determinants of BoNT-A Treatment Discontinuation in Patients Living with Spasticity: A 10-Year Retrospective Analysis

Cinone

Santoro

Spina

et al. 2022

Toxins

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Background: The present study aimed to evaluate the reasons and determinants of BoNT-A discontinuation in patients with stroke, multiple sclerosis, spinal cord injury, and traumatic brain injury. Methods: It is a retrospective study of 56 discontinuer patients treated with botulinum toxin between January 2011 and December 2021. Discontinuation rates and their predictors were estimated using Kaplan–Meier, Log rank test, and Cox’s regression method of analyses.Results: The mean age was 56.54 years, 53.57% were affected by post-stroke spasticity, 17.86% by spinal cord injury, 12.5% and 16.07% by traumatic brain injury and multiple sclerosis, respectively. The median discontinuation time was 5 months. The main reason for discontinuation were logistic problems (37%) and orthopedic surgeries or intrathecal baclofen (27%). Discontinuers were more likely to have severe spasticity (R = 1.785), have no pain (HR = 1.320), no access to rehabilitation services (HR = 1.402), and have cognitive impairment (HR = 1.403). Conclusions: The main reasons for discontinuation are related to logistic issues (due to distance or the absence of an adequate caregiver) and surgical interventions for spasticity, including intrathecal baclofen. It is crucial to identify possible predictors of discontinuation to improve the effectiveness of a multidisciplinary management. The study confirms the crucial role of rehabilitation and caregivers in achieving better long-term outcomes.

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Section: Discussionmentioning

confidence: 99%