Effect of treatment with botulinum toxin type A (Dysport ®) on health-related quality of life in patients with equinovarus deformity after stroke

Abstract

Botulinum toxin is effective to treat post-stroke lower limb's spasticity. However, the impact of BTX therapy on the quality of life (QoL) of patients is not known. We aimed to evaluate the effect of Botulinum toxin type A (Dysport®) on QoL in post-stroke calf spasticity and to correlate the functional outcome measures with eventual changes in QoL. We included 24 patients (16 M, 8F) who had suffered a stroke at least 3 months earlier. All the patients presented equinovarus deformity for spasticity, were able to walk for at least 10 m with orthesis but showed a speed of walking <90% of normal over a distance of 10 m. QoL was measured by SF-36. Outcome measures of effectiveness were: 2-min walking test; FAC, RMA, active and passive ROM of the affected ankle; Modified Ashworth Scale (MAS) for assessment of spasticity severity; pain. After infiltration with BTX-A, all outcome measures of effectiveness improved significantly (ANOVA repeated measures). After treatment, spasticity decreased (reduction MAS p<0.001), FAC and RMA improved (p<0.001), 2-min walking distance increased (p<0.006) and pain's score decreased (p<0.001). Participants in the study compared to the general population had a lower score for SF-36 and had a worse perception of their health. After administration of BTX-A there was no significant amelioration for the physical and mental health scores of SF-36.