Treatment of chronic limb spasticity with botulinum toxin A.

Dunne, John W.; Heye, N.; Dunne, S L

doi:10.1136/jnnp.58.2.232

Cited by 142 publications

(59 citation statements)

References 5 publications

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“…This may have implications across the large number of centres used in this study. However, previous studies on the use of BoNT-A in post-stroke spasticity have demonstrated an improvement in spasticity [12, 14, 27, 30, 31, 32, 33, 34]. The greater change in spasticity with dysport 1,500 units may be due to the significantly higher baseline scores, which had more scope for change.…”

Section: Discussionmentioning

confidence: 75%

A Double-Blind Randomised Placebo-Controlled Evaluation of Three Doses of Botulinum Toxin Type A (Dysport<sup>®</sup>) in the Treatment of Spastic Equinovarus Deformity after Stroke

Pittock¹,

Moore²,

Hardiman³

et al. 2003

Cerebrovasc Dis

182

173

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Background/Objectives: Calf muscle hypertonicity following stroke may impair walking rehabilitation. The aim of this study was to assess botulinum toxin (Dysport^®) in post-stroke calf spasticity. Methods: A prospective, multicentre, double-blind, placebo-controlled, dose-ranging study was performed to evaluate dysport at 500, 1,000 or 1,500 units in 234 stroke patients. They were assessed at 4-week intervals over 12 weeks. Results: The primary outcome measure, 2-min walking distance and stepping rate increased significantly in each group (p < 0.05, paired test), but there was no significant difference between groups (including placebo). Following dysport treatment, there were small but significant (p = 0.0002–0.0188) improvements in calf spasticity, limb pain, and a reduction in the use of walking aids, compared to placebo. Investigators’ and patients’ assessments of overall benefit suggested an advantage for dysport over placebo, but this was not significant. Sixty-eight patients reported 130 adverse events, with similar numbers in each group. The few severe events recorded were not considered to be treatment-related. Conclusion: Dysport resulted in a significant reduction in muscle tone, limb pain and dependence on walking aids. The greatest benefits were in patients receiving dysport 1,500 units, but 1,000 units also had significant effects. Dysport 500 units resulted in some improvements. Since few adverse events were reported, this therapy is considered safe and may be a useful treatment in post-stroke rehabilitation of the leg. Possible reasons why functional improvements in gait parameters were not observed are also discussed.

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Section: Discussionmentioning

confidence: 75%

A Double-Blind Randomised Placebo-Controlled Evaluation of Three Doses of Botulinum Toxin Type A (Dysport<sup>®</sup>) in the Treatment of Spastic Equinovarus Deformity after Stroke

Pittock¹,

Moore²,

Hardiman³

et al. 2003

Cerebrovasc Dis

182

173

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“…9 Others report a lack of improved function after local 5 or general 6 treatment of lower limb spasticity, whereas others report good results, 32 especially with neurotomy 8,9 or botulinum toxin A. [12][13][14] Hinderer and Gupta 33 emphasized that very few of the functional scales are operational for monitoring changes related to spasticity. Although patients were selected for the studies, the selection criteria were not given.…”

Section: Discussionmentioning

confidence: 99%

“…4 In hemiplegic stroke patients, treating lower limb spasticity has often failed to improve gait significantly. 4 -7 Some good results have been obtained with neurotomy 8 -10 and botulinum toxin A, [11][12][13][14] but only a small percentage of these patients could benefit from such treatments. In these different studies, the authors considered spasticity to produce a disabling posture of the lower limb, impairing gait by stance equinus, or to generate handicap via an unexplained mechanism.…”

mentioning

confidence: 99%

A Clinical Guide to Assess the Role of Lower Limb Extensor Overactivity in Hemiplegic Gait Disorders

Yelnik

Albert

Bonan

et al. 1999

Stroke

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Background and Purpose-The aim of this study was to assess the role of knee and ankle extensor overactivity in the hemiplegic gait observed in stroke victims and to propose a clinical guide for selecting patients before treatment of a supposed disabling spasticity. Methods-A standardized physical examination procedure was performed in 135 consecutive stroke patients. All patients were able to walk without human assistance. The period after stroke ranged from 3 to 24 months (mean, 11.5Ϯ7.25 months). Spasticity was evaluated with the stroke victim in sitting position and during walking. Overactivity of the quadriceps was considered disabling when inducing inability to flex the knee during the swing phase despite adequate control of knee flexion in sitting and standing positions; overactivity of the triceps surae was considered to be disabling when heel strike was not possible despite good control of the ankle flexion in sitting position; triceps retraction was also considered. Results-Disabling overactivity was observed in 56 (41.5%) patients: 11 times for the quadriceps femoris, 21 times for the triceps surae, and 21 times for both muscles. It was considered to be the main disorder impairing gait among only 16 (12%) patients: 9 for the quadriceps alone, 3 for the triceps alone, and 4 for both. Sitting spasticity of the lower limb was not predictive of disabling overactivity during walking. Conclusions-Extensor muscle overactivity is one of the components of gait disorders in stroke patients. The difficulty in assessing spasticity and its real causal effect in gait disturbances are discussed. A clinical guide is proposed. (Stroke. 1999;30:580-585.)

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“…Previous open trial studies have reported substantial amelioration in the muscle tone of spastic patients, both in the upper9 11-13 and lower limbs. '0 [13][14][15][16][17][18][19] To confirm the apparent effectiveness of BTX, double blind, placebo controlled studies have been called for, 20 21 and this we set out to do in a population of adult hemiparetic patients with ankle plantar flexor and foot invertor spasticity.…”

mentioning

confidence: 99%

A randomised, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients.

Burbaud

Wiart

Dubos

et al. 1996

Journal of Neurology, Neurosurgery & Psychiatry

218

163

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Objective-To confirm the apparent effectiveness of botulinum toxin (BTX) in hemiparetic patients with ankle plantar flexor and foot invertor spasticity. Methods-Twenty three hemiparetic patients with spasticity of the ankle plantar flexors and foot invertors were included in a randomised double blind, placebo controlled study with BTX. Patients were examined on days 0, 30, 90, and 120 and received one injection of BTX and one of placebo in a random order at day 0 and day 90. Results-Patients reported a clear subjective improvement in foot spasticity after BTX (P = 0-0014) but not after placebo. Significant changes were noted in Ashworth scale values for ankle extensors (P < 0.0001) and invertors (P = 0.0002), and for active ankle dorsiflexion (P = 0-0001). Gait velocity was slightly but not significantly (P = 0-0731) improved after BTX injections. The severity of spasticity did not modify treatment efficacy, but BTX was less effective in patients with longer duration of spasticity (P = 0-0081). Conclusion-The efficacy of BTX injections in the treatment of spastic foot suggests that BTX may be particularly useful during the first year after a stroke.

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Treatment of chronic limb spasticity with botulinum toxin A.

Cited by 142 publications

References 5 publications

A Double-Blind Randomised Placebo-Controlled Evaluation of Three Doses of Botulinum Toxin Type A (Dysport<sup>®</sup>) in the Treatment of Spastic Equinovarus Deformity after Stroke

A Double-Blind Randomised Placebo-Controlled Evaluation of Three Doses of Botulinum Toxin Type A (Dysport<sup>®</sup>) in the Treatment of Spastic Equinovarus Deformity after Stroke

A Clinical Guide to Assess the Role of Lower Limb Extensor Overactivity in Hemiplegic Gait Disorders

A randomised, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients.

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