Botulinum toxin type "A" in the treatment of post-stroke upper limb spasticity

الملخص EN

Objective: After stroke, abnormal arm posture due to spasticity in a functionally useless arm that can lead to significant physical problems including spasm, restricted range of movement, pain and contractures as well as functional difficulties of self care tasks and maintenance of personal hygiene.

Many agents have been used to treat spasticity, yet a successful treatment still presents a challenge.

Aim of work: The present study was performed to evaluate the efficacy and safety of Btx-A on spastic upper limb after stroke.

Patients and Methods: Twenty-eight patients with upper limb spasticity due to stroke were considered for local intramuscular injection of Btx-A.

Their mean age was 56.2±7.9 years, eighteen were males and ten were females.

The patients with hemiplegic stroke were recruited at least 3 months (range 3-60 months) after the onset of stroke.

Patients had a muscle tone score of >2 on the modified Ashworth scale in the elbow, wrist and finger flexors.

Seventy to 300 units of Botox (with a mean of 165.7±108.2 U) were given for each patient at the target spastic muscle using EMG guidance.

The efficacy of treatment was evaluated using a combination of subjective and objective measures at intervals of 1, 2, 4, 8, 12 weeks after injection to assess changes in both impairment and functional disabilities.

The safety of Btx-A was evaluated by recording any adverse events of the studied medication.

Results: Our results showed a significant reduction of spasticity after Btx-A injection as measured by modified Ashworth and spasm frequency scores.

Pain and range of movement of the upper limb joints were positively influenced by reduction of spasticity but higher values were obtained in passive movement in comparison with active one.

On the other hand, grip strength declined in our series.

Functional abilities were reported with a significant improvement in the present series.

Improvement in functional disabilities was obtained 2 weeks post-injection of Btx-A while changes of other outcome measures were obtained within a week.

Both the etiology of stroke and duration of disability after stroke had no significant relationship to our gains.

However, younger patients <50 years had slightly (non significant) better improvement of pain and functional scores.

Side effects were local, mild and reversible within few days post-injection.

Conclusion: Btx-A is a safe, well tolerated, potent and effective treatment of focal spastic upper limb muscle following stroke.