Botulinum toxin injection into the forearm muscles for wrist and fingers spastic overactivity in adults with chronic stroke: a randomized controlled trial comparing three injection techniques

Picelli, Alessandro; Lobba, Davide; Midiri, A.; Prandi, Paolo; Melotti, Camilla; Baldessarelli, Silvia; Smania, Nicola

doi:10.1177/0269215513497735

Cited by 75 publications

(68 citation statements)

References 23 publications

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“…In line with growing evidence of the usefulness of electrical stimulation/electromyography and ultrasonography guidance, the panelists agreed that localization techniques are essential for onabotulinumtoxinA treatment of all postures due to post-stroke spasticity (Picelli et al, 2012a;Picelli et al, 2012b;Picelli et al, 2014a;Picelli et al, 2014b;Grigoriu et al, 2015;Esquenazi et al, 2017;Simpson et al, 2017).…”

Section: Organizational Care Modelmentioning

confidence: 88%

Management of spasticity with onabotulinumtoxinA: practical guidance based on the italian real-life post-stroke spasticity survey

Sandrini

Baricich

Cisari

et al. 2018

Functional Neurology

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SummaryThe present paper provides practical guidance on the management of adult spasticity with OnabotulinumtoxinA. Advisory Board members reviewed the available evidence and discussed their personal experiences in order to address the unmet needs in the management of spasticity with botulinum toxin type A identified by the recent Italian Real-Life PostStroke Spasticity Survey. Stroke patients should be referred to spasticity services that have adequate facilities and multidisciplinary teams with the necessary training, competence and expertise. The current literature shows a strong correlation between the development of post-stroke spasticity and the degree of central sensorimotor system destruction/disorganization. Use of tools such as the Poststroke Checklist may help clinicians in the long-term follow-up of stroke patients. The maximum dose of onabotulinumtoxinA -according to the current literature this ranges from 300U to 400U for upper limb and from 500U to 600U for lower limb aggregate postures -should be re-considered. In addition, there is a need for future consensus (also based on pharmacoeconomic considerations) on consistent clinical care models for the management of patients with post-stroke spasticity.

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Section: Organizational Care Modelmentioning

confidence: 88%

Management of spasticity with onabotulinumtoxinA: practical guidance based on the italian real-life post-stroke spasticity survey

Sandrini

Baricich

Cisari

et al. 2018

Functional Neurology

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show abstract

“…A possible explanation might be the use of ultrasonography to identify target muscles; in fact, as reported by Henzel et al (2010), ultrasound localization may improve accuracy of needle placement, avoiding injection into vascular structures and reducing the potential risk of systemic diffusion of BoNT-A. Moreover, this technique can improve clinical outcome both in upper and lower limb PSS (Picelli et al 2014;Santamato et al 2014).…”

Section: Discussionmentioning

confidence: 98%

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

Baricich¹,

Grana

Carda

et al. 2015

J Neural Transm

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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.

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“…Use of these techniques can optimize clinical efficacy. Although studies have shown that EMG-and ultrasonography-guided injection of BoNT is more likely to reach the targeted muscle as well as its endplate in treatment of spasticity, 17,18 it remains unclear whether injections using EMG or ultrasonography guidance result in greater functional improvement than nonguided injections. Although generally payers will not question EMG or ultrasound for BoNT, there are no clear payer policies on the use of guided injections, and their use depends on the experience and comfort level of the individual providers.…”

Section: Other Considerationsmentioning

confidence: 99%

Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache

Govindarajan

Shepard

Moschonas³

et al. 2016

Neur Clin Pract

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This article is presented as a companion to the American Academy of Neurology guideline update on the use of botulinum neurotoxin (BoNT) for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache. Whereas the guideline update provides clarity on the efficacy of different BoNT-branded preparations for the 4 listed indications, this companion piece identifies ambiguities in the evidence for efficacy among various brand names for a given clinical indication, their dosing equivalencies, as well as different clinical indications. This article provides guidance and background information to reduce obstacles for third party payment, especially when uncertainties exist and levels of evidence are lower. Neurol Clin Pract 2016;6:281-286 T he first American Academy of Neurology (AAN) guideline on the use of botulinum toxin (BoNT), published in 2008, focused predominantly on the pharmacology and immunology of the toxin.1-3 The guideline also reviewed a variety of clinical indications, with recommendations of efficacy based on the toxin as a whole. Furthermore, there was insufficient evidence to recommend the use of BoNT for chronic migraine.Since then, there has been more evidence on the efficacy of different brand formulations for different indications as well greater understanding of the differences in pharmacology and immunology between the toxin A and B serotypes and branded formulations. However, there are

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Botulinum toxin injection into the forearm muscles for wrist and fingers spastic overactivity in adults with chronic stroke: a randomized controlled trial comparing three injection techniques

Abstract: Instrumental guidance may improve the outcome of botulinum toxin injections into the spastic forearm muscles of stroke patients.

Cited by 75 publications

References 23 publications

Management of spasticity with onabotulinumtoxinA: practical guidance based on the italian real-life post-stroke spasticity survey

Management of spasticity with onabotulinumtoxinA: practical guidance based on the italian real-life post-stroke spasticity survey

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

Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache

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