Abstract
The short-term effects of botulinum toxin type A (BoNT-A) treatment in stroke patients with upper extremity are well established. This study examined the association between the recovery of motor function of the upper extremity with subjective physical symptoms in outpatients receiving long-term BoNT-A and occupational therapy following stroke. We also investigated the expectations of patients who elected to continue treatment. Forty-seven patients (23 men and 24 women) aged 61 years received BoNT-A treatment more than 20 times. The subjective physical status was analyzed by using the visual analogue scale score through an eight-item questionnaire. Recovery of motor function in the upper extremity was detected by calculating the change (delta) in Fugl–Mayer Assessment (FMA), and ordinal logistic modeling analysis was used to determine the association between the delta-FMA score and the subjective level of agreement for each item. When the ordinal logistic modeling fit was statistically significant, results were interpreted as having logistic probability. The logistic curves discriminating one point (strongly disagree) from five points (strongly agree) were fit in a stepwise fashion. This study suggests that patients receiving long-term BoNT-A treatment and occupational therapy experienced an increased upper extremity mitigation and decreased insomnia after injection, regardless of the recovery of motor function.
Highlights
Patients with post-stroke hemiplegia often suffer from spasticity [1,2]
We investigated the expectations for subjective physical status of patients who continued for treatments
Our results suggested that long-term treatment could improve subjective symptoms of sleeplessness and arm weakness caused by sequelae of stroke without recovery of motor function in upper extremity, while decreasing pain
Summary
Patients with post-stroke hemiplegia often suffer from spasticity [1,2]. Severe spasticity combined with motor paralysis decreases the ability to perform activities typical of daily living [3,4]. Botulinum toxin type A (BoNT-A) inhibits the signal transmission by acetylcholine at the neuromuscular junction of the motor nerves, resulting in a muscle relaxation, and is effective in suppressing pain and spasticity [5,6]. BoNT-A treatment is recommended as a grade A treatment for stroke patients in the clinical practice guidelines in Japan, and is a strongly recommended treatment for severe hemiplegia [7]. The efficacy of BoNT-A is attenuated in three to four months following administration [8,9]
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