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

ABSTRACT

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