Botulinum toxin in post-stroke patients: stiffness modifications and clinical implications

Miscio, Giacinta; Conte, Carmen Del; Pianca, Danilo; Colombo, Roberto; Panizza, Marcela; Schieppati, Marco; Pisano, Fabrizio

doi:10.1007/s00415-004-0297-3

Cited by 45 publications

(27 citation statements)

References 51 publications

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“…121,127 ). An influence on intrafusal fibre function of this toxin was discussed 128,129 . Nevertheless, there are also reports indicating, that intrathecal baclofen can reduce hyperactive reflexes without producing significant weakness [130][131][132] .…”

Section: Therapeutical Consequencesmentioning

confidence: 99%

Spastic movement disorder: impaired reflex function and altered muscle mechanics

Dietz

Sinkjær

2007

The Lancet Neurology

496

332

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In clinical practice the dominant view is that the signs of exaggerated tendon tap reflexes associated with muscle hypertonia are responsible for the spastic movement disorder. Consequently, most anti-spastic treatments are directed at reducing reflex activity. During the last years an increasing body of evidence suggests a discrepancy between clinical spasticity and spastic movement disorder.This is primarily due to the different role reflexes play in the passive and active condition, respectively. Today we know that a central motor lesion is associated with a loss of supraspinal drive and a defective utilization of afferent input with an impaired behaviour of short-and longlatency reflexes. This leads to a paresis and a mal-adaptation of the movement pattern.Secondary changes in mechanical muscle fibre, collagen tissue and tendon properties (e.g. loss of sarcomers; sub-clinical contractures) result in spastic muscle tone, which at part compensates for paresis. This allows functional movements on a simpler level of organisation. Anti-spastic drugs can accentuate paresis and therefore should be applied with caution in mobile subjects.

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Section: Therapeutical Consequencesmentioning

confidence: 99%

Spastic movement disorder: impaired reflex function and altered muscle mechanics

Dietz

Sinkjær

2007

The Lancet Neurology

496

332

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“…30 The concern that botulinum toxin may cause significant weakening of muscles and therefore reduced function seems not to occur, with some authors reporting increased strength. 34 A recent European consensus statement on the use of botulinum toxin in adult spasticity provides the necessary advice about indication and treatment.…”

Section: Spasticitymentioning

confidence: 98%

Role of botulinum toxin in hand and upper limb disorders relevant to hand therapy

Keir¹,

Giele²

2009

Hand Therapy

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Introduction. This article reviews the mechanism of action of botulinum toxin and provides an overview of its use in hand disorders relevant to hand therapy such as hyperhidrosis, spasticity, dystonia, tremor, Parkinson's, obstetrical brachial plexus palsy, flexor tendon rehabilitation, lateral epicondylitis, Raynaud's and carpal tunnel syndrome. Methods. A narrative review of the literature retrieved through electronic databases using keywords botulinum toxin, hand, therapy, and reviewing the bibliographic references cited. Results. Sixty-five original articles and meta-analyses were reviewed. The number and quality of the published reports for each disorder are very variable but generally botulinum toxin is reported to be an effective adjunct to therapy in the treatment of a wide variety of hand and upper limb pathologies. Discussion. A surprising number of hand and upper limb conditions have been successively treated with botulinum toxin, but most require botulinum toxin to be used in conjunction with hand therapy to achieve more effective outcomes for longer duration. Neuromuscular disorders seem to be most responsive to botulinum toxin treatment. Therapists should be aware of the potential benefits of botulinum toxin injections for a wide range of hand disorders and when appropriate discuss these with patients and other health professionals. Conclusion. Botulinum toxin has an effective and growing role in hand therapy.

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“…[2][3][4][5][6][7]9,[11][12][13][14][15] Of the reviewed studies, results showed statistical significance of improving spasticity in the muscles injected with BTX-A.…”

Section: Spasticity Scalesmentioning

confidence: 99%

Botulinum Toxin Type A and Post-stroke Spasticity of the Upper Limbs

Ivanhoe¹,

Eaddy-Rose²

2009

US Neurology

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Stroke is the leading cause of disability in the US and is a major global health problem. It has been identified as one of the largest causes of lost productivity in late adulthood. The multiple life-altering complications that result from stroke-such as paresis, mood disorders, aphasia, cognitive deficits, dysarthria, dysphagia, and visual disturbances-may be confounded by the development of spasticity. Upper-limb spasticity can be particularly debilitating.Spasticity is considered to be a positive sign of the upper motor neuron syndrome (UMNS) and, as such, is associated with exaggerated tendon jerks and repetitive stretch reflex discharges, or 'clonus.' Spasticity is a disorder of the sensorimotor system defined as an involuntary, velocitydependent resistance to stretch, caused by a hyperexcitable stretch reflex. Spasticity is often a key component of a person's experience of impaired mobility and activities of daily living, pain, skin breakdown, poor hygiene, insomnia, social isolation, and poor quality of life (QoL). These conditions also have a significant impact on care-giver burden. Treatment options for post-stroke spasticity include oral spasmolytics (e.g. baclofen, dantrolene, and diazepam) and may not be tolerated by patients due to their non-selective nature and systemic side effects such as sedation, dizziness, nausea, cognitive dysfunction, and general weakness. AbstractBackground: Stroke is a significant contributor to morbidity and mortality in the US and other developed nations. Stroke and its side effects are

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Botulinum toxin in post-stroke patients: stiffness modifications and clinical implications

Abstract: BT can be considered a valid therapeutic tool in all spastic patients, because of immediate advantages: reduction of muscle hypertonia, pain relief, improvement in selected motor performances.

Cited by 45 publications

References 51 publications

Spastic movement disorder: impaired reflex function and altered muscle mechanics

Spastic movement disorder: impaired reflex function and altered muscle mechanics

Role of botulinum toxin in hand and upper limb disorders relevant to hand therapy

Botulinum Toxin Type A and Post-stroke Spasticity of the Upper Limbs

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