Efficacy and safety of botulinum toxin type A (Dysport) for the treatment of post-stroke arm spasticity: results of the German-Austrian open-label post-marketing surveillance prospective study.

The current practice in Germany and Austria, and the safety and efficacy of botulinum toxin type A (BoNT-A; Dysport) in the treatment of patients with post-stroke arm spasticity (with no fixed upper-limb contractures), were assessed in this observational prospective non-interventional study. One treatment cycle was documented with assessments at baseline, approximately week 4 (optional), and approximately week 12. Pattern of spasticity, treatment goal, safety and efficacy were recorded. Overall response and goal achievement was rated on a 4-point scale ('no goal achievement', 'goal achievement', 'good goal achievement', 'best goal achievement'). In total, 409 patients were included and 99% assigned to one of five arm-spasticity patterns. Therapy goals included reduced muscle tone (92.6%), physiotherapy or occupational therapy support (63.8%), increased range of motion (61.8%), pain reduction (58.9%), facilitation of care or hygiene (55.7%), and functional improvement (17.0%). Goals were achieved in 84% of patients. The following factors had the most potential as predictors of treatment outcome: pre-treatment; time since onset of spasticity; pattern of arm spasticity. Mean Dysport dose was 728 U and an inverse dose-response relationship was observed. Treatment was well tolerated. 500-1000 U was a safe and effective treatment for post-stroke arm spasticity in this post-marketing evaluation.

Classification of posture in poststroke upper limb spasticity: a potential decision tool for botulinum toxin A treatment?

A significant percentage of patients suffering from a stroke involving motor-relevant central nervous system regions will develop a spastic movement disorder. Hyperactivity of different muscle combinations forces the limbs affected into abnormal postures or movement patterns. As muscular hyperactivity can effectively and safely be treated with botulinum toxin type A (BoNT-A), we present a classification of spastic arm movement patterns to support BoNT-A therapy of arm spasticity. A few characteristic patterns can be distinguished that may be relevant for BoNT-A treatment. On the basis of a differentiated posture and arm movement analysis, five characteristic arm spasticity patterns (ASP I-V) were defined with respect to the position of the shoulder, elbow, forearm, and wrist joints. These patterns were verified using data from a worldwide noninterventional Upper Limb International Survey. By clinical observation, spastic arm postures in 94% of 665 poststroke patients could be assigned to one of these five ASPs. The most frequent pattern of arm spasticity was ASP III (41.8%) with internal rotation and adduction of the shoulder and flexion at the elbow coupled with a neutral positioning of the forearm and wrist, not the typical Wernicke-Mann position. These five different arm position patterns (ASP I-V) form the foundation of a common terminology and facilitate quick and understandable exchange of information with other physicians. Furthermore, utilization of these patterns may improve the dosing, goal setting, and outcome of the BoNT-A treatment of arm spasticity.