Focal shock waves increase efficacy and prolong the effect of botulinum toxin on spasticity in patients with brain injury from stroke and multiple sclerosis.

Abstract

Assess the effects on spasticity reduction of the association between focal extracorporeal shock wave therapy and botulinum toxin type A, versus the toxin only in brain injury patients. Eighteen patients were included. The study had two phases: the first phase was observational, and botulinum toxin type A was used. The second was a prospective, deliberate intervention phase in which the toxin was injected and focal extracorporeal shock wave treatment was added (1 sessions/week, for three weeks). The patients were followed up in the 1st, 4th and 6th month, the Ashworth Scale criterion was applied and, for those with lower limb involvement and changes in walking the 10-metre walk test was used. Patients treated with toxin only showed a statistically significant improvement in spasticity, with 1 point on the Ashworth Scale from week 5, which disappeared at week 17. However, the combined therapy reduced spasticity by 2 points from week 1 to week 25 (p < 0.001), with a faster result in the 10-meter gait test (p = 0.004). Combined and simultaneous treatment with botulinum toxin and focal extracorporeal shock wave reduced spasticity in a more effective and prolonged way than treatment with botulinum toxin only.