Early Botulinum Toxin Type A Injection for Post-Stroke Spasticity: A Longitudinal Cohort Study.

Alessandro Picelli,Cristina Del Prete,Michela Cosma,Marzia Millevolte,Carmelo Chisari,Paolo Girardi,Andrea Santamato,Alessio Baricich,Nicola Smania,Ilenia Mazzù

doi:10.3390/toxins13060374

Abstract

Early management of spasticity may improve stroke outcome. Botulinum toxin type A (BoNT-A) is recommended treatment for post-stroke spasticity (PSS). However, it is usually administered in the chronic phase of stroke. Our aim was to determine whether the length of time between stroke onset and initial BoNT-A injection has an effect on outcomes after PSS treatment. This multicenter, longitudinal, cohort study included stroke patients (time since onset <12 months) with PSS who received BoNT-A for the first time according to routine practice. The main outcome was the modified Ashworth scale (MAS). Patients were evaluated before BoNT-A injection and then at 4, 12, and 24 weeks of follow-up. Eighty-three patients with PSS were enrolled. MAS showed a significant decrease in PSS at 4 and 12 weeks but not at 24 weeks after treatment. Among the patients with a time between stroke onset and BoNT-A injection >90 days, the MAS were higher at 4 and 12 weeks than at 24 weeks compared to those injected ≤90 days since stroke. Our findings suggest that BoNT-A treatment for PSS should be initiated within 3 months after stroke onset in order to obtain a greater reduction in muscle tone at 1 and 3 months afterwards.

Highlights

There was no significant difference between other characteristics and patient sex (Table 1)
Botulinum toxin type A (BoNT-A) injection in patients with poststroke spasticity (PSS) at more than 6 months after stroke [13,18]. With this longitudinal cohort study, we wanted to determine whether the time between stroke onset and initial BoNT-A injection had an effect on the outcome of naïve patients with PSS in real-life clinical practice
This observation is shared by a metanalysis of six randomized controlled trials conducted by Rosales and colleagues, who reported on the beneficial effects of BoNT-A treatment on PSS within

Summary

Introduction

Spasticity is a positive symptom of UMNS and has been defined as “a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex” [2]. The prevalence of spasticity after first-ever stroke is 4–27% within the first 6 weeks, 19% at 3 months, 21.7–42.6% between 4 and 6 months, and 17–38% at 12 months from onset [3,4,5]. Spasticity may impact on the disability of stroke patients [6,7]. Prediction of poststroke spasticity (PSS) can help to prevent (if possible) its onset, slow or limit its progression [8]. Detection of PSS can improve the long-term outcome of stroke patients [3,8,9]

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