Role of BoNT-A in patient with post COVID-19 spasticity, assessed by H-reflex

Abstract

Background. COVID-19 is a pandemic disease due to viral infection. It spread throughout the world, and the association of COVID-19 with neuroendocrine system is a well-known fact especially while the connection between the endocrine and immune system neuroinflammation play a crucial role in pathophysiology. Therapeutic indication of Botulinum-neurotoxin-A (BoNT-A) is used in the treatment of focal post-stroke spasticity (PSS) and in re-habilitation which is regarded as a safe and effective type of treatment. Objective. To assess spasticity after COVID-19 infection. Methods. Thirty patients diagnosed as post-COVID-19 stroke spasticity were enrolled, their age ranged from (30-60 years). They had focal spasticity of lower extremities. BoNT-A was given in day 0 and 4 weeks later, in the gastrocnemius and soleus muscle. H-reflex was recorded from soleus muscles at 1st presentation and 4 weeks after injection of BoNT-A. Muscle power was assessed by Medical Research Council scale (MRC) and MAS. Results. The amplitude and latency of H-reflex record from soleus muscles and the H/M ratio showed a statistically significant difference between pre- and post-therapy with BoNT-A injection in cases with post COVID-19 spasticity. There was a significant increase in MRC scale but, MAS scale showed a significant reduction after injection of BoNT-A. Conclusion. Post COVID spasticity is a well-known complication after COVID-19 infection, there was clinical improvement in PSS post BoNT-A injections, which was assessed clinically by MAS and MRC scale, neurophysiological the H-reflex was correlated negatively regarding latency, while there was no correlation regarding H-reflex amplitude or Hmax/Mmax ratio and MAS.