Our experience with interamuscular injections of botulinum toxin A for the treatment of upper limb flexors spasticity after stroke

Focal spasticity can be a major drawback in the rehabilitation of stroke patients. Previous studies suggest a beneficial effect of Botulinum toxin A[Botox A] for relief of spasticity. To evaluate the therapeutic effects of intramuscular injections of Botox A [Btx A] on spasticity of the upper limb. D e s i g n: An open-label non-controlled trial for a duration of 16 weeks was design to determine the e fficacy and safety of intramuscular Btx A injections in the treatment of 56 patients with spastic hemiparesis after stroke. The patients were assessed at baseline, 2, 4, 12 and 16 weeks after treatment by several outcome measures - modified Ashworth scale, motricity index arm score, limb position at rest, semi-quantitative o rdinal scale for severity of pain, patient's global response to Btx A t reatment, Barthel index of activities of daily living, difficulties encountered during thre e upper limb motor tasks. Significant reduction of muscle tone, spasticity related pain and improvement in the three selected functional tasks [cleaning the palm of the affected hand, cutting the fingernails of the affected hand, putting the affected arm into the sleeve] were observed one week after Btx A injections and were sustained throughout the 16 weeks follow-up period. Botox A is effective and safe adjunctive treatment to on-going rehabilitation for patients with post - stroke localized moderate-to-severe spasticity refractory to physical and medical treatments

Neck pain, neck mobility and alignment of cervical spine in 30 patients with cervical strain

Neck pain due to acute and repetitive neck injuries is a common complaint in the general population. Functional assessment of cervical spine by measurement of cervical range of movements [CROM] is informative and beneficial for planning proper treatment of patients with cervical strain. Muscle spasm is the widely used explanation for straightening and reversal of cervical lordosis commonly seen after trauma, but more specific interpretation is not supported in the literature. To evaluate the intensity of neck pain, the mobility of cervical spine and the cervical curve in patients with chronic cervical strain. Semiquantitative ordinal scale was used for evaluation of the severity of neck pain. Assessment of cervical movements was performed using cervical gonimeter with three separate inclinometers, measuring the movements in frontal, sagittal and horizontal planes. Two line Cobb method was used to determine the angle of cervical curve on lateral cervical radiographs. Significant reduction of total active CROM was found in patients with cervical strain with predominantly restricted neck extension followed by neck flexion, lateral flexion and to a lesser extent rotation. No significant difference was found in the prevalence of lordotic, straight and kyphotic curves in the group of patients with cervical strain compared to those in the control group. In our study, the existence of CROM limitation in cervical strain patients did not show a different than normal distribution of lordotic, straight and kyphotic cervical spine on radiographic images established by Cobb method

Serum levels of insulin-like growth factor-1 in patients with osteoarthritis of the knee

Insulin related growth factor-1 [IGF-1] is an important growth promoting peptide which has anabolic effects on cartilage metabolism. The fact that serum levels tend to decrease in elderly subjects while osteoarthritis [OA] increases in prevalence suggests that suboptimal levels of IGF-1 may play a part in the development of OA. This study therefore considers the hypothesis that IGF-1 levels are low in subjects with OA of the knee. Serum levels of 48 patients with symptomatic knee OA and radiographic changes of different grade were compared with normal controls. No significant difference was found in serum levels between cases and controls [mean [SD] 20,67 [7.73] for cases and 23.91 [12.0] mmol for controls]. No significant correlations were shown between IGF-1 levels, age and total radiographic score. The study provides no evidence that serum levels of IGF-1 are low in OA