Role for botulinum toxin in back pain treatment in adults with cerebral palsy: report of a case.

OBJECTIVE: To report a case illustrating the usefulness of botulinum toxin A in the treatment of spinal dystonia responsible for low back pain and postural disorders. METHODS: Critical appraisal of a case report. CASE REPORT: A young woman with cerebral palsy had lumbar paraspinal muscle dystonia responsible for pain and hyperlordosis unresponsive to oral medications for muscle spasm. Botulinum toxin A (Botox(R), 200 U) was injected into the paraspinal muscles at six sites, to good effect. DISCUSSION: The few reported cases consistently show a favorable effect of local botulinum toxin A injections in patients with painful paraspinal muscle dystonia related to neurological disease or chronic low back pain. CONCLUSION: Botulinum toxin A may be a useful treatment for incapacitating painful dystonia of the paraspinal muscles. This treatment improves posture in the sitting position and facilitates the fitting of orthotic devices. Furthermore, botulinum toxin A treatment may help to determine whether an intrathecal baclofen test is in order.

Prognostic factors in the recovery of the ability to walk after stroke.

We have studied the recovery of walking ability on being discharged from a department of physical medicine and rehabilitation in patients with hemiplegia after stroke, and the factors influencing this recovery. This prospective study was based on 93 patients. The patients, who were considered to be ambulatory, were able to move 10 metres on their own or with supervision when they were discharged. The potentially influential factors studied were: age, the aetiology and the side of hemiplegia, co-morbidity, the delay in starting rehabilitation, the neurological damage evaluated by the middle cerebral artery scale of Orgogozo, the initial functional damage evaluated by the functional score carried out within the scale of Functional Independence Measure (FIM), the existence of aphasia, of a depressive or hemineglect syndrome, presence of superficial or profound sensory disorders, incontinence at the start of rehabilitation and at one month after stroke, the existence of cognitive or psychiatric disorders. The non-parametric Mann-Whitney, the chi2, and the correlation test were used. The threshold of significance was .05. Based on 93 patients (47 women and 46 men, average age 64.8) 87.1% were walking at discharge, on average 3 months after stroke. The predictive factors or those linked to an absence of recovery were the presence of superficial sensory disorders, the initial neurological damage, the initial functional damage, the presence of a depressive syndrome, and urinary incontinence. We stress the significance of the sensorimotor and initial functional damage, and of incontinence in establishing a prognosis for recovery of walking ability, in order to decide the objectives and the rehabilitative treatment for each patient.