Botulinium toxin type-A and spasticity due to traumatic spinal cord injury

ABSTRACT

Spasticity is a prevalent disabling clinical symptom for spinal cord injuries patients. Treatment of spasticity with botulinium toxin is helpful in focal, controlled muscle weakness with reduction in spasticity. To evaluate the effect of botulinium toxin type A on spasticity in spinal cord injured patients and its effect on functional outcome. Forty patients with spasticity due to traumatic spinal cord injury were included in the study. Initial assessment includes general and neurological examination to detect the level, ASIA classification, motor power. Spasticity grading using clonus score, global pain scale, spasm frequency scale, adductor tone scale and modified ashowrth scale.Functional assessment using activity of daily living [ADL] measures, lower extremity muscle strength [LEMS] and functional impairment measure [FIM] rating levels of disability, these assessment were done at the start, at 3 months and 6 months.All patients received regular conventional physiotherapy rehabilitation programs on daily bases for 3 months then three times per week for another 3 months. Thirty patients of them [group I] received botulinium toxin type A in the spastic muscles and the dose was calculated according to the body weights, 10 patients [group II] didn't receive botulinium toxin type A. There was no significant difference between group I and group II as regard ADL, at start and at 3 and 6 months. The FIM results showed no significant difference between group I and II at start but there was a statistical significant lower mean FIM in group 2 at 3 and 6 months. In group I there was a significant increase in FIM mean at 3 months and significant decrease at 6 months, on the other hand group II showed a significant decrease FIM mean at 3 and 6 months.Clonus score showed no significant difference between group I and group Il at start and at 3 months but significant higher score of grade 3 and 4 was observed at 6 months in group II. There was a significant lower clonus score at 3 months in group I with no change at 6 months on the other hand there was a significant higher score at 3 months with no change at 6 months in group II. Spasm frequency scale showed no significant difference between group I and group II at start but there was a significant higher rate of scale 3 and 4 in group II at 3 and 6 months. In group I, there was a significant change of spasm frequency scale at 3 and 6 months with tendency towards lower scale, although group II showed no significant change at 3 and 6 months. Global pain scale showed no significant difference between group I and II at start, 3 and 6 months. In group I there was a significant decrease in pain scale after 3 months with no change at 6 months while in group II there was no significant difference at 3 months with significant increase at 6 months compared to 3 months. Adductor tone scale results showed no significant difference between group I and II at start but significant higher rate of scale 3 and 4 was observed in group II at 3 and 6 months. Group I showed a significant decrease of adductor tone scale at 3 and 6 months while group II showed no significant change at Smonths with significant increase at 6 months. Modified ashowrth scale showed no significant difference between group I and II at start with significant higher rate of scale 3 and 4 in group II at 3 and 6 months. Group I showed a significant decrease in modified ashowrth scale at 3 and 6 months, while group II showed significant increase in scale at 3 months with no change at 6 months compared to 3 months but there was an increase in scale at 6 months compared to the start. The botulinium toxin has a reducing effect of spasticity in spinal cord injured patients -.consequently, it improves their functional outcome. It is recommended to use it on more frequent bases as it helps to improve spasticity safely and decreases the dose of central muscle relaxant with reduction of its adverse effect