Limb Spasticity In Post-stroke Patients Research Articles

Effects of High-Intensity Electromagnetic Stimulation on Reducing Upper Limb Spasticity in Post-Stroke Patients

Super Inductive System (SIS) stimulation of spastic limbs by tissue-induced electromagnetic field may have the effect of reducing spasticity and improving functionality in patients with post-stroke spasticity. The aim of the study was to evaluate two different protocols for the application of SIS on upper limb spasticity after stroke. We included 60 patients with post-stroke upper limb spasticity, who were randomized into two groups: the study group, with a 9 min application protocol (1 min for agonist muscles, 8 min for antagonistic muscles); and the control group, with an 8 min protocol applied only to the antagonistic muscles. The duration of therapy was 10 days, and the results were assessed using the Modified Ashworth Scale (MAS) and the Barthel Index. Both the MAS and the Barthel Index improved significantly after 10 days of treatment (p < 0.001), but 30 days after the completion of therapy, there was an attenuation of the effects in both study groups. The study group had a significantly higher percentage of patients with improved MAS after 10 days (p = 0.004) and within 30 days (p < 0.001) than the control group. An SIS protocol applied on both agonist and antagonist muscles has a more pronounced and longer lasting spasticity-reducing and improved functionality effect than its application on only antagonistic muscles.

Botulinum Toxin Type A for Upper Limb Spasticity in Poststroke Patients: A Meta-analysis of Randomized Controlled Trials

Background and Aim: Botulinum toxin type A is considered to be an effective antispasmodic in recent years. We assess the effectiveness of botulinum toxin type A for the treatment of poststroke spasticity in the upper extremity using a meta-analysis. Methods: We searched several databases including PubMed, Web of Science, Embase, and Cochrane database for relevant studies, up until October 2017. All randomized controlled trials of botulinum toxin type A treat poststroke upper limb spasticity published were included. The primary outcome measure was modified ashworth score at the elbow, finger and wrist, pain score, and barthel index. Results: Ten randomized controlled trials were identified and reported sufficient data for inclusion in the pooled analysis (n = 950). The results of modified ashworth score at different joints, pain score, barthel index showed no difference was found in the effectiveness of botulinum toxin type A compared with placebo in the treatment of the upper limb spasticity after stroke. But modified ashworth score at the elbow was improver in Dysport subgroups (standardized mean difference [SMD] = −.39, 95%CI = −.67 to −.10, P = .008) compared with Botox subgroups (SMD = .08, 95%CI = −.68 to .83, P = .84). Conclusions: The meta-analysis of these studies showed that the overall effectiveness of botulinum toxin type A does not seem to differ from placebo for poststroke Patients. But the meta-analysis yielded a favorable effect of Dysport compared with placebo based on 4 trials.

F波、H反射在卒中后肢体痉挛疗效评估中的研究进展 Progress of F Wave and H Reflex in Effect Evaluation of Antispastic Treatment of Limb Spasticity in Post-stroke Patients

F波、H反射在卒中后肢体痉挛疗效评估中的研究进展 Progress of F Wave and H Reflex in Effect Evaluation of Antispastic Treatment of Limb Spasticity in Post-stroke Patients

Clinical study of combined mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients.

Mirror therapy is a simple, inexpensive, and patient-oriented method that has been shown to reduce phantom sensations and pain caused by amputation and improve range of motion, speed, and accuracy of arm movement and function. Extracorporeal shock wave therapy (ESWT) is a new, reversible, and noninvasive method for the treatment of spasticity after stroke. To investigate the therapeutic effect of the combination of mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients. We randomly assigned 120 patients into four groups: A, B, C, and D. All groups received conventional rehabilitation training for 30 min per day, five times a week, for 4 weeks. Moreover, participants in groups A, B, and C also added mirror therapy, ESWT, and a combination of mirror and ESWT, respectively, for 20 min per day. Motor recovery and spasticity were measured using Fugl–Meyer assessment and modified Ashworth scale. The differences in the Fugl–Meyer assessment and modified Ashworth scale scores in group C were significantly greater than those of group D at all observed time points after treatment and were significantly greater than those of groups A and B (P<0.05), but no significant differences were observed between groups A and B until 12 months. Upper extremity spasticity was improved by combined mirror and ESWT.

Effects of botulinum toxin A therapy and multidisciplinary rehabilitation on upper and lower limb spasticity in post-stroke patients

Objectives. The purpose of this study was to examine the effects of combined botulinum toxin type A (BoNT-A) and inpatient multidisciplinary (MD) rehabilitation therapy on the improvement of upper and lower limb function in post-stroke patients. Methods. In this retrospective study, a 12-day inpatient treatment protocol was implemented on 51 post-stroke patients with spasticity. Assessments were performed on the day of admission, at discharge, and at 3 months following discharge. Results. At the time of discharge, all of the evaluated items showed a statistically significant improvement. Only the Functional Reach Test (FRT) showed a statistically significant improvement at 3 months. In subgroup analyses, the slowest walking speed group showed a significantly greater change ratio of the 10 Meter Walk Test relative to the other groups, from the time of admission to discharge. This group showed a greater FRT change ratio than the other groups from the time of admission to the 3-month follow-up. Conclusion. Inpatient combined therapy of simultaneous injections of BoNT-A to the upper and lower limbs and MD may improve motor function.

Botulinum toxin type A in post-stroke lower limb spasticity: a multicenter, double-blind, placebo-controlled trial

Lower limb spasticity in post-stroke patients can impair ambulation and reduces activities of daily living (ADL) performance of patients. Botulinum toxin type A (BoNTA) has been shown effective for upper limb spasticity. This study assesses the treatment of lower limb spasticity in a large placebo-controlled clinical trial. In this multicenter, randomized, double-blind, parallel-group, placebo-controlled study, we evaluate the efficacy and safety of one-time injections of botulinum toxin type A (BoNTA) in Japanese patients with post-stroke lower limb spasticity. One hundred twenty patients with lower limb spasticity were randomized to a single treatment with BoNTA 300 U or placebo. The tone of the ankle flexor was assessed at baseline and through 12 weeks using the Modified Ashworth Scale (MAS). Gait pattern and speed of gait were also assessed. The primary endpoint was area under the curve (AUC) of the change from baseline in the MAS ankle score. Significant improvement in spasticity with BoNTA 300 U was demonstrated by a mean difference in the AUC of the change from baseline in the MAS ankle score between the BoNTA and placebo groups (−3.428; 95% CIs, −5.841 to −1.016; p = 0.006; t test). A significantly greater decrease from baseline in the MAS ankle score was noted at weeks 4, 6 and 8 in the BoNTA group compared to the placebo group (p < 0.001). Significant improvement in the Clinicians Global Impression was noted by the investigator at weeks 4, 6 and 8 (p = 0.016–0.048, Wilcoxon test), but not by the patient or physical/occupational therapist. Assessments of gait pattern using the Physician’s Rating Scale and speed of gait revealed no significant treatment differences but showed a tendency towards improvement with BoNTA. No marked difference was noted in the frequency of treatment-related adverse events between BoNTA and placebo groups. This was the first large-scale trial to indicate that BoNTA significantly reduced spasticity in lower limb muscles.

Efficacy and Safety of Botulinum Toxin Type A in treating Upper Limb Spasticity in Post-stroke Patients : A Multicenter, Double-blind, Placebo-controlled Trial followed by an Open-label Trial

【目的】脳卒中後の上肢痙縮患者を対象にA型ボツリヌス毒素製剤 (botulinum toxin type A：BTXA) 単回投与時の有効性をプラセボを対照として検証し，反復投与した際の有効性および安全性を評価した．【方法】上肢痙縮患者109 例にBTXA低用量(120～150 単位)，高用量(200～240 単位)またはプラセボを手関節，手指関節，母指関節 (母指に痙縮が認められた場合) の対象筋に1 回筋注し，投与12 週以降は再投与基準を満たした被験者にBTXA 200～240 単位を最大3 回反復投与し48 週まで観察を行った．【結果】手関節のModified Ashworth Scale (MAS)の投与前からの変化量に基づく曲線下面積の平均値の差はBTXA高用量群とプラセボ群間で—6.830であり，プラセボ群に対して有意な減少が認められた(p<0.001，t検定)．反復投与によりMASは更なる改善を示した．副作用発現頻度はBTXA群，プラセボ群間で著明な差は認められず，反復投与においても副作用発現率の増加は認められなかった．【結論】BTXAは初回投与から上肢痙縮を改善し，長期的に有効で安全な治療法に成り得ると考えられた．

Efficacy and Safety of Botulinum Toxin Type A in treating Lower Limb Spasticity in Post-stroke Patients : A Multicenter, Double-blind, Placebo-controlled Trial followed by an Open-label Trial

【目的】脳卒中後の下肢痙縮患者を対象にA 型ボツリヌス毒素製剤(botulinum toxin type A：BTXA)単回投与時の有効性をプラセボを対照として検証し，反復投与した際の有効性および安全性を評価した．【方法】下肢痙縮患者120 例にBTXA300 単位またはプラセボを対象筋に1 回筋注し，投与12 週以降は再投与基準を満たした被験者にBTXA300 単位を最大3 回反復投与し，48 週まで観察を行った．【結果】足関節のModified Ashworth Scale(MAS)の投与前からの変化量に基づく曲線下面積の平均値の差は，BTXA群とプラセボ群間で-3.428であり，BTXA群で有意な減少が認められた(p=0.006，t検定)．反復投与によりMASは更なる改善を示した．副作用発現頻度はBTXA群，プラセボ群間で著明な差は認められず，反復投与において副作用発現率の増加は認められなかった．【結論】BTXAは初回投与から下肢痙縮を改善し，長期的に有効で安全な治療法に成り得ると考えられた．

Poster 364: Consistent Efficacy of Botulinum Neurotoxin Type A: A Meta-Analysis From 7 Multicenter Studies of Upper Limb Spasticity in Post-Stroke Patients

Poster 364: Consistent Efficacy of Botulinum Neurotoxin Type A: A Meta-Analysis From 7 Multicenter Studies of Upper Limb Spasticity in Post-Stroke Patients

Poster Abstract #1: Passive and Active Functional Tasks Are the Main Reasons for Treatment of Upper Limb Spasticity in Post-Stroke Patients Among Neurologists, Physiatrists, and Primary Care Physicians

Poster Abstract #1: Passive and Active Functional Tasks Are the Main Reasons for Treatment of Upper Limb Spasticity in Post-Stroke Patients Among Neurologists, Physiatrists, and Primary Care Physicians

Toxine botulinique et pharmacie hospitalière

Botulinum toxin is a neurotoxic protein synthesized by Clostridium botulinum. Among approved indications for type A pharmaceutical formulations is the treatment of upper limb spasticity in post-stroke patients. Neurologists and rehabilitator physicians have extended their use to treat other types of muscles spasticity. In 2002, most of prescriptions in France were off-label. The activity of the R. Poincaré hospital is dedicated to treating handicapped patients. Working in close collaboration, prescribing physicians and hospital pharmacists elaborated a set of guidelines for the use of botulinum toxin type A. The protocol includes a specific order form, pharmaceutical validation of prescriptions and distribution follow-up. The numbers of prescriptions and treated patients have greatly increased from 2003 to 2005. As a consequence to the extension of marketing authorization for indications for the use of botulinum toxin type A in 2005, 77% of treated therapeutic indications are now compliant to marketing authorization specifications. Through prescription analysis, in-hospital pharmacists participate in the implementation of guidelines for follow-up and management of medical expenditures.