Use of botulinum toxin in stroke patients with severe upper limb spasticity.

Bhakta, Bipin; Cozens, J. A.; Bamford, John; Chamberlain, M A

doi:10.1136/jnnp.61.1.30

Cited by 174 publications

(112 citation statements)

References 11 publications

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“…We found that the effects of BTX-A at 1 month continued through month 3, which was compatible with the literature. Bhakta et al (32) showed that the effects of BTX-A were sustained 11 months later in patients who were also involved in a regular rehabilitation program. Findings reported in some studies including a decrease in effectiveness at 12 months and differences in functional status may be caused by insufficient dose, patient selection, existence of contractures, and lack of effective and sufficient rehabilitation program (3,7,10).…”

Section: Discussionmentioning

confidence: 99%

“…An effective physical therapy and rehabilitation program in the early period of stroke is necessary for the improvement of spasticity, and studies showed that a combination of BTX-A and physical therapy and rehabilitation program was better than using them separately (32,33,34,35). In our study, all patients were included in a physical therapy and rehabilitation program in the early period of stroke, which might account for the improvement in all scales.…”

Section: Discussionmentioning

confidence: 99%

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The Evaluation of Botulinum Toxin Injection Effect for Poststroke Spasticity Treatment

Demiryürek¹,

Gündoğdu²

2017

tnd

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Amaç: Bu çalışmada, inme sonrası üst ya da alt ekstremite spastisitesi gelişen hastaların tedavisinde Botulinum toksin-tip A (BTX-A) enjeksiyonunun spastisite ve spastisiteye bağlı ağrı tedavisindeki etkinliği ile günlük yaşam aktivitelerine olan etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem:Bu çalışmaya inme sonrası üst ekstremite ya da alt ekstremitede spastisite nedenli 249±41 U BTX-A uygulanmış 35 (23 sağ taraf, 12 sol taraf) hasta alındı. Üst ekstremitede dirsek, el bileği ve parmaklarda, alt ekstremitede ise bacak, diz ve ayak bileğinde spastisite derecesi; BTX-A enjeksiyonu öncesi, işlem sonrası 1. ay ve işlem sonrası 3. ay Modifiye Ashworth Skalası (MAS) ile değerlendirildi. Ayrıca BTX-A işlemi öncesi, işlem sonrası 1. ay ve işlem sonrası 3. ay günlük yaşam aktiviteleri Barthel indeksi ile, spastisiteye bağlı ağrı ise Vizüel Analog Skalası (VAS) ile değerlendirildi. Bulgular: Çalışmaya alınan hastaların yaş ortalaması 60±6 idi. Hastaların %69'unda üst ve alt ekstremite, %31'inde ise üst ya da alt ekstremite etkilenmişti. MAS, VAS ve Barthel indeksi kullanılarak BTX-A'nın tedavi öncesine göre anlamlı olarak spastisite ve ağrı şiddetinde azalma, fonksiyonellikte ve yaşam kalitesinde ise artma sağladığı sonucuna varıldı. Birinci ayda sağlanan faydanın 3. ay takiplerinde de sürdüğü saptandı.Sonuç: İnmeye bağlı spastisite tedavisinde BTX-A uygulanması yan etki açısından güvenli, hastaların ağrısını azaltan, fonksiyonelliği ve yaşam kalitesini artıran, uzun süreli etkinlik sağlayabilen bir yöntemdir.Anahtar Kelimeler: İnme, spastisite, botulinum toksin, ağrıObjective: In this study we aimed to evaluate the effectivity of treatment with the botulinum toxin-type A (BTX-A) on spasticity, spasticity-related pain, and the daily living activities in post-stroke patients with upper or lower limb spasticity. Materials and Methods:A total of 35 (23 right side, 12 left side) post-stroke patients who had upper and/or lower limb spasticity were enrolled to the study. BTX-A (249±41 U) was applied to their affected extremities. The degree of spasticity in the upper (elbow, wrists, and fingers) and lower (leg, knee and ankle) extremities was evaluated before treatment, 1 month, and 3 months after treatment using Modified Ashworth Scale (MAS). Daily life activities and severity of spasticity-related pain were also evaluated using the Barthel index and Visual Analogue Scale (VAS) at the same time points. Results:The average age of the patients in the study was 60±6 years. Both upper and lower extremities were affected in 69%, whereas upper or lower extremities were affected in 31% of patients. BTX-A provided improvement in severity of the spasticity, pain scale, functionality, and quality of life according to the MAS, VAS, and Barthel indexes.The benefits were sustained in the first 3 months of the post-treatment.Conclusion: BTX-A in the treatment of post-stroke spasticity is a reliable method in terms of adverse effects, pain reduction, its ability to provide long-term effectiveness, and increase functionality an...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Evaluation of Botulinum Toxin Injection Effect for Poststroke Spasticity Treatment

Demiryürek¹,

Gündoğdu²

2017

tnd

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“…Muscles were located by palpation and were injected at the standard site used for electromyography (EMG). 7 The NM technique consisted of a sliding mobilization of the sciatic nerve. The NM treatment started the day after the BoNT-A injection and continued for 4 sessions per week for a total period of 4 weeks.…”

Section: Case Reportmentioning

confidence: 99%

“…Lower limb spasticity causes severe functional limitations and pain. [5][6][7] Botulinum toxin type A derived from C botulinum, when injected into a spastic muscle, inhibits acetylcholine release, causing blockade of the neuromuscular patches without affecting the antagonist muscles. 8 Preliminary reports have suggested a role for botulinum toxin in the treatment of spasticity because it can reduce the degree of spasticity in both the upper and lower limbs.…”

Section: Introductionmentioning

confidence: 99%

Botulinum toxin type A combined with neurodynamic mobilization for lower limb spasticity: a case report

Villafañe¹

2013

Journal of Chiropractic Medicine

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Objective: This case report describes a patient with severe lower limb spasticity treated with botulinum toxin type A (BoNT-A) and neurodynamic mobilization (NM). Clinical Features: An 81-year-old male patient presented with a severe spastic lower limbs after total right hip replacement and severe alcoholic polyneuropathy. After the right hip replacement, he presented with generalized spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his knees prevented walking. Intervention and Outcome: The patient underwent combined treatment with BoNT-A and NM of the lower limb in 4 weekly applications. Evaluations were performed pretreatment, 4 weeks after the injection, and at a follow-up session 9 months after finishing treatment. We measured the following outcomes: pain by the Numerical Rating Scale, spasticity by the Modified Ashworth Scale for Grading Spasticity, acceptance and emotional reaction to the treatment by the Hospital Anxiety and Depression Scale, and functionality by ranges of motion. We found that the patient improved in all of the outcomes after treatment, and these results were maintained during the follow-up. After treatment, the patient was able to improve wound healing by properly positioning himself in bed or on his wheelchair and walking with help. At the follow-up evaluation, the results were maintained. The patient showed good acceptance and decreased anxiety/depression after treatment. Conclusion: For this patient, the combination of NM and BoNT-A treatment decreased pain and spasticity and improved joint ranges of motion.

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“…The muscle was localized by the standard anatomical landmarks used in needle electromyography. 21 Standard dilutions of BoNT-A in isotonic sodium chloride solution were used.…”

Section: Case Reportmentioning

confidence: 99%

Botulinum toxin type A combined with cervical spine manual therapy for masseteric hypertrophy in a patient with Alzheimer-type dementia: a case report

Villafañe¹,

Fernández‐de‐las‐Peñas

Pillastrini

2012

Journal of Chiropractic Medicine

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Objective: The purpose of this case study is to present the findings of combining botulinum toxin type A (BoNT-A) and cervical spine manual therapy to address masseter muscle spasticity in a patient with Alzheimer-type dementia. Case Report: A 78-year-old woman with bilateral spasticity of the masseteric regions for 2 years was referred for physiotherapy. She had trismus and bruxism, and could neither close nor open her mouth normally; thus, she was unable to be fed orally in a normal manner. Intervention and Outcome: The patient underwent combined treatment with BoNT-A and cervical spine manual therapy. A medical physician (neurologist) performed the BoNT-A injections into 2 points at the center of the lower third of the masseter muscle. A physical therapist performed manual therapy interventions targeted at the cervical spine. Manual therapy started the day after the BoNT-A injection and continued for 5 sessions per week for a total period of 2 weeks. Clinical outcomes were measured including spasticity (Modified Ashworth Scale), functionality (Barthel Index), and jaw opening. Outcomes were conducted at baseline, 2 weeks after treatment, and at 2-month follow-up session after finishing the treatment. The patient improved in all of the outcomes at the end of treatment, and these Journal of Chiropractic Medicine (2012) 11, 280-285 results were maintained during the follow-up. After treatment, the patient was able to feed with minimal caregiver dependency because oral feeding was possible. Conclusion:The patient in this study responded positively to a combination of BoNT-A and manual therapy, resulting in decreased masseter muscles spasticity and improved trismus and bruxism.

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Use of botulinum toxin in stroke patients with severe upper limb spasticity.

Cited by 174 publications

References 11 publications

The Evaluation of Botulinum Toxin Injection Effect for Poststroke Spasticity Treatment

The Evaluation of Botulinum Toxin Injection Effect for Poststroke Spasticity Treatment

Botulinum toxin type A combined with neurodynamic mobilization for lower limb spasticity: a case report

Botulinum toxin type A combined with cervical spine manual therapy for masseteric hypertrophy in a patient with Alzheimer-type dementia: a case report

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