Repeated abobotulinumtoxinA injections benefit walking speed, step length and cadence in adults with spastic hemiparesis due to stroke or traumatic brain injury

Abstract

Patients with chronic hemiparesis following stroke or traumatic brain injury (TBI) often experience restricted walking performance. Our previous double-blind (DB) trial of 388 patients demonstrated that abobotulinumtoxinA (aboBoNT-A) treatment improves muscle tone and functional outcomes in adults with lower limb spastic paresis. This sub-analysis from the open-label (OL) study extension phase assesses changes in walking speed (WS), step length (SL) and cadence in these patients. Phase 3, prospective, multicentre, double-blind (DB), randomised study (single injection of aboBoNT-A 1000U or 1500U or placebo; NCT01249404 ), followed by an OL study extension (≤ 4 cycles of aboBoNT-A 1000U or 1500U; NCT01251367 ). Participants were ambulatory adults with spastic hemiparesis causing gait dysfunction, comfortable barefoot WS 0.1–0.8 m/s in 10-metre WS test without walking aids, and stroke or TBI ≥ 6 months before study enrolment. Patients receiving either aboBoNT-A dose were assessed relative to DB baseline for WS, SL and cadence using 10-metre WS tests under different conditions (maximal and comfortable WS, barefoot and with shoes). Week 12 data are shown for the last treatment cycle with available data (cycle 3). Relative to baseline, improvements in WS, SL and cadence by OL Cycle 3 Week 12 were observed in all four categories ( Table 1 ). Mean percentage of improvements in WS were +19.7–23.6% across categories. Mean percentage improvements of +9.4–13.8% and +7.2–9.7% were observed for SL and cadence, respectively. The highest mean percentage improvements were at comfortable barefoot WS for WS and SL, and at maximal barefoot WS for cadence. The least improvements from DB baseline were observed with shoes compared with barefoot, across all categories. Substantial improvements in WS, SL and cadence were achieved over time in hemiparetic adults with repeated administration of aboBoNT-A.