Post-stroke Lower Limb Spasticity Research Articles

Poster 22 OnabotulinumtoxinA Treatment in Adult Patients with Post-Stroke Lower Limb Spasticity: Results from a Double-Blind, Placebo-Controlled, Phase 3 Clinical Trial

PM&RVolume 7, Issue 9S p. S98-S99 Friday Poster Presentation Poster 22 OnabotulinumtoxinA Treatment in Adult Patients with Post-Stroke Lower Limb Spasticity: Results from a Double-Blind, Placebo-Controlled, Phase 3 Clinical Trial Alberto Esquenazi MD, Alberto Esquenazi MD MossRehab, Elkins Park, PA, United StatesSearch for more papers by this authorTheodore Wein MD, Theodore Wein MD MossRehab, Elkins Park, PA, United StatesSearch for more papers by this authorWolfgang H. Jost MD, PhD, Wolfgang H. Jost MD, PhD MossRehab, Elkins Park, PA, United StatesSearch for more papers by this authorAnthony B. Ward BSc, MD, FRCPEd, FRCP, Anthony B. Ward BSc, MD, FRCPEd, FRCP MossRehab, Elkins Park, PA, United StatesSearch for more papers by this authorTinna Kwan PhD, RN, Tinna Kwan PhD, RN MossRehab, Elkins Park, PA, United StatesSearch for more papers by this author Alberto Esquenazi MD, Alberto Esquenazi MD MossRehab, Elkins Park, PA, United StatesSearch for more papers by this authorTheodore Wein MD, Theodore Wein MD MossRehab, Elkins Park, PA, United StatesSearch for more papers by this authorWolfgang H. Jost MD, PhD, Wolfgang H. Jost MD, PhD MossRehab, Elkins Park, PA, United StatesSearch for more papers by this authorAnthony B. Ward BSc, MD, FRCPEd, FRCP, Anthony B. Ward BSc, MD, FRCPEd, FRCP MossRehab, Elkins Park, PA, United StatesSearch for more papers by this authorTinna Kwan PhD, RN, Tinna Kwan PhD, RN MossRehab, Elkins Park, PA, United StatesSearch for more papers by this author First published: 08 September 2015 https://doi.org/10.1016/j.pmrj.2015.06.063Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume7, Issue9SSeptember 2015Pages S98-S99 RelatedInformation

High doses of onabotulinumtoxinA in post-stroke spasticity: a retrospective analysis

We retrospectively evaluated the efficacy and safety of high doses of onabotulinumtoxinA (from 600 to 800 units) in 26 patients affected by upper and/or lower limb post-stroke spasticity. They were assessed before, 30 and 90 days after treatment. We observed a significant muscle tone reduction and a significant functional improvement (assessed with the Disability Assessment Scale). No adverse events were reported. In our retrospective analysis the treatment with high doses of onabotulinumtoxinA showed to be effective and safe.

198. A study to assess relief of pain associated with spasticity in patients with post-stroke lower limb spasticity treated with botulinum toxin type A (BoNT-A) (RELIEF)

198. A study to assess relief of pain associated with spasticity in patients with post-stroke lower limb spasticity treated with botulinum toxin type A (BoNT-A) (RELIEF)

58. Effectiveness of Botulinum toxin A (BoNT-A) in adults with post-stroke lower limb spasticity in Spain: goal attainment after one injection cycle

58. Effectiveness of Botulinum toxin A (BoNT-A) in adults with post-stroke lower limb spasticity in Spain: goal attainment after one injection cycle

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

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

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.

Poster 43: Passive and Active Functional Tasks: Main Reasons for Treatment (or Referral for Treatment) of Upper-Limb Spasticity in Poststroke Patients Among Neurologists, Physiatrists, and Primary Care Physicians

Objective: To determine major reasons for treatment (or referral) of poststroke upper-limb spasticity patients among 3 leading specialties. Design: Internet-based survey. Setting: Physicians in full-time practice. Participants: Of 523 physicians contacted, 50 neurologists, 50 physiatrists, and 300 primary care physicians (PCPs) fulfilled eligibility criteria and completed the survey. Interventions: Physician demographics and poststroke spasticity patient characteristics were collected. Main Outcome Measures: Average number per month of adult stroke patients treated and/or referred and with upper- and/or lower-limb poststroke spasticity; type of deformity; and treatment goals. Results: Adult stroke patients treated by neurologists and physiatrists and seen by PCPs per month were 23.8, 17.9, and 38.6, respectively, of which approximately half had spasticity in the upper and/or lower limb (10.3, 10.0, 12.5, respectively). Majority of upper-limb spasticity patients had severe finger or wrist spasticity. Main treatment goals in this population were to relieve pain or discomfort and improve access to the palm for hygiene (passive function) or improve the ability to grasp or hold objects (active function). Conclusions: Surveyed physicians evaluate and treat a significant number of poststroke spasticity patients suffering from passive and active functional consequences. Hand pain and discomfort and inability to access palm for hygiene or use the hand for grasping or holding were major reasons for treatment.

The effects of isotonic and isokinetic muscle stretch on the excitability of the spinal alpha motor neurones in patients with muscle spasticity

To examine the effect of isotonic (with and without weight bearing) and isokinetic muscle stretch on the excitability of the spinal alpha motor neurones (alphaMN) in patients with spasticity and to establish whether this effect is maintained for at least 24 h after the intervention. A single 20-min session of isotonic muscle stretch (with or without weight bearing) or isokinetic stretch was delivered to the ankle plantar flexors in patients with post-stroke lower limb spasticity and healthy control subjects. The effect of these types of muscle stretch on the excitability of alphaMN was assessed by measuring the latency of the Hoffmann reflex (H-reflex) and the ratio of the amplitude of the maximum H-reflex (H(max)) to that of the maximum action motor potential of the soleus muscle (M(max)). Sixty-six hemiplegic stroke patients and 21 healthy control subjects were recruited and completed the trial. The H(max):M(max) ratio was significantly higher in patients with spasticity than in healthy control subjects. However, there were no statistically significant differences in the H-reflex latency or the change in H(max):M(max) ratio between the baseline values and those recorded immediately after the therapy intervention or 24 h later for each type of muscle stretch. Similarly, there were no significant differences in these variables between the interventions. In the present study neither isotonic muscle stretch (with or without weight bearing) or isokinetic stretch had a statistically significant effect on the excitability of the alphaMN in patients with muscle spasticity. This suggests that the previously reported reduction in spasticity after muscle stretch is because of mechanisms other than the direct effect on alphaMN. However, the lack of a demonstrable benefit of treatment may be due the fact that we examined the effects of a single, rather than repeated treatment cycles.

Hémiplégie vasculaire : membre inférieur et toxine botulique (Revue)

Objective. – To clarify the conditions governing the use of botulinum toxin (BTX) for post-stroke lower limb spastic disorders: indications, choice of muscles, doses, and duration of efficacy. Method. – Review of the international literature using the Medline and the Reedoc data banks. Results. – Seven controlled studies were reviewed, including in particular 2 studies vs placebo and one vs phenol, 7 open studies or case series closely related to this topic and 4 open studies partly dedicated to it. The usefulness of BTX for the treatment of equinovarus has been demonstrated. The main muscles to be treated are the soleus, gastrocnemius and tibialis posterior. The treatment proposed for toe clawing is BTX injection into the flexor digitorum longus and flexor hallucis longus, and for great toe permanent extension, injection of the extensor hallucis longus. The quadriceps femoris, the tibialis anterior or the hamstrings have only be treated in isolated cases. When the treatment is effective, its benefit may last for more than 6 months. Discussion. – A few controlled trials have demonstrated the efficacy of BTX for post stroke lower limb spasticity. The results of all the controlled and open trials argue in favor of its efficacy, but this still requires more thorough analysis. Conclusion. – Botulinum toxin has a place together with other local treatments for post-stroke spasticity, but a precise guide to its use, especially its dosage, and it’s effectiveness compared to that of other treatments, need further study.