Abstract
Many neurological diseases (ischemic and hemorrhagic stroke, multiple sclerosis, infant cerebral palsy, spinal cord injuries, traumatic brain injury, and other cerebrovascular disorders) may cause muscle spasticity. Different therapeutic strategies have been proposed for the treatment of spasticity. One of the major treatments for tone modulation is botulinum toxin type A (BTX-A), performed in addition to other rehabilitation strategies based on individualized multidisciplinary programs aimed at achieving certain goals for each patient. Therapeutic plans must be precisely defined as they must balance the reduction of spastic hypertonia and retention of residual motor function. To perform and optimize the treatment, an accurate clinical and instrumental evaluation of spasticity is needed to determine how this symptom is invalidating and to choose the best doses, muscles and times of injection in each patient. We introduce an “appropriate treatment” and no “standard or high dosage treatment” concept based on our retrospective observational study on 120 patients lasting two years, according to the larger Therapeutic Index and Therapeutic Window of Incobotulinumtoxin A doses from 100 to 1000 units. We studied the efficiency and safety of this drug considering the clinical spasticity significance for specialist physicians and patients.
Highlights
IntroductionComprehending the various mechanisms of muscle tone alteration and the quantitative evaluation of muscle rheological modifications can lead to the development of more precise and targeted therapeutic interventions for the treatment of spasticity [2,3]
Spasticity is the most common complication of many neurological diseases followed by ischemic and hemorrhagic stroke, multiple sclerosis, infant cerebral palsy, spinal cord injuries, traumatic brain injury, and other cerebrovascular disorders [1].Comprehending the various mechanisms of muscle tone alteration and the quantitative evaluation of muscle rheological modifications can lead to the development of more precise and targeted therapeutic interventions for the treatment of spasticity [2,3]
Dosage was increased in 10 patients (33%) due to poor clinical effects or to treat more muscles, so they switched to group B
Summary
Comprehending the various mechanisms of muscle tone alteration and the quantitative evaluation of muscle rheological modifications can lead to the development of more precise and targeted therapeutic interventions for the treatment of spasticity [2,3]. There is a reduction in type II fibers and an increase in type I fibers. It is an involuntary motor disorder, characterized by hypertonic muscle tone with increased excitability of the muscle relaxation reflex and increased tendon reflexes. Muscle weakness or paresis in the limbs is associated with spasticity and contributes to loss of motor dexterity and functional capacity [4]. Spasticity, if left untreated, can hinder the functional result by promoting persistent abnormal postures which produce muscle-tendon contractions and bone deformities.
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