Botulinum toxin type A for the treatment of arm and hand spasticity in stroke patients

Sampaio, Cristina; Ferreira, Joaquim J.; Pinto, Anabela; Crespo, Manuela; Ferro, José M.; Castro-Caldas, Alexandre

doi:10.1177/026921559701100102

Cited by 65 publications

(39 citation statements)

References 8 publications

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“…Our results are in accordance with recent studies [3, 16, 21], although several former investigations failed to demonstrate a functional effect [9, 10, 11]. The most frequently discussed reason for these differences is the heterogeneity of the patients’ functional states.…”

Section: Discussionsupporting

confidence: 93%

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Is the Reduction of Spasticity by Botulinum Toxin A Beneficial for the Recovery of Motor Function of Arm and Hand in Stroke Patients?

Woldag

Hummelsheim²

2003

Eur Neurol

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To determine the functional benefit of botulinum toxin A (BtxA) in spasticity of arm flexors, we conducted an open-label study with 10 stroke patients. 480 mouse units BtxA (Dysport^®) were injected into flexor muscles. Outcome measures were done by the Modified Ashworth Scale, Rivermead Motor Assessment (arm section), active and passive ranges of motion (ROM), grip strength and a 3-dimensional motion analysis. The functional capacity of the entire arm, even of the shoulder, and the ROM of fingers and wrist increased. Despite a diminution of muscle tone, grip strength remained unchanged or increased. An improvement of forearm extension was only observed in cases of preserved voluntary extensor motricity. Injection of BtxA into spastic distal flexor muscles may lead to a functional improvement of the entire arm. Grip strength is not necessarily reduced.

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Section: Discussionsupporting

confidence: 93%

“…In a number of studies, BtxA proved to be beneficial, safe and, albeit expensive, cost effective in the management of spasticity of upper and lower limbs [3, 4, 5, 6, 7, 8, 9, 10, 11]. …”

Section: Introductionmentioning

confidence: 99%

Is the Reduction of Spasticity by Botulinum Toxin A Beneficial for the Recovery of Motor Function of Arm and Hand in Stroke Patients?

Woldag

Hummelsheim²

2003

Eur Neurol

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“…Botulinum toxin A is more and more widely used, as the reduction in focal spasticity is higher than that obtained with medications and physiotherapy [2,9,32]. Furthermore, this reduction is often associated with an increase in passive [3,13,31] and active [30] ranges of motion. Several studies have also suggested that botulinum toxin injection can improve the posture of the upper limb and the comfort of patients and caregivers [3,4,18,33].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of botulinum toxin A in upper limb function of hemiplegic patients

Rousseaux¹,

Kozlowski²,

Froger³

2002

J Neurol

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Botulinum toxin A has been reported to reduce spasticity and increase the comfort of hemiplegic patients. The aim of this study was to assess the efficacy of the treatment on disability, especially in manual activities, and to attempt to identify predictive factors of improvement. Twenty patients (mean age: 54.4 years; M: 14; right hemiplegia: 12) were included, with a delay of at least three months after unilateral hemispheric stroke. Botulinum toxin A (BOTOX) was injected into the arm adductors (8 cases), forearm flexors (17 cases), pronators, wrist and finger flexors (20 cases),with a total dose of 200 to 300 U. Examination (day 1 and 15, month 2 and 5) consisted of spasticity assessment (modified Ashworth scale), muscle strength, passive range of motion (goniometry), and pain, followed by functional tests, especially the Rivermead Motor Assessment (RMA) and Nine-hole Peg Test (NHPT). Performance in daily living was assessed with the Functional Independence Measure (FIM), and an original analysis of hand grasp, grip and pinches used in domestic activities (9 items), and of comfort of patients and caregivers. Significant reduction in spasticity was observed on the elbow flexors, pronators, wrist and fingers flexors, especially at day 15 (mean 0.90 to 1 point), with wide variations in effect. Muscle strength was increased in wrist and fingers extensors, with concomitant increase in the opening of the thumb to index finger space. There was no effect on the NHPT requiring distal manipulation, but the RMA, which especially concerned picking up and releasing a tennis ball, showed significant improvement. Furthermore, use of the upper limb in daily living increased, particularly for internal grasping of objects, and for grasping by the top, transporting and releasing of objects. Patients and caregivers re ported facilitation in dressing, and in proximal and distal care of the upper limb. The global flexor position of the limb improved. Ad verse reactions were rare and mostly consisted of transitory pain during injection. The improvement in the RMA was better explained by the quality of the initial motor command on distal prehension (positive correlation with motor strength), and that in hand using in domestic activities by a lower level of spasticity on pronators and wrist flexors (negative correlations with spasticity). Conversely, the severity of the motor deficit (negative correlations with motor strength) and a high level of spasticity before injection (positive correlations with spasticity) mostly explained the improvement in comfort. In conclusion, botulinum toxin A is efficient in improving hand use in patients with relatively preserved distal motricity, and in increasing comfort in patients with severe global disorders.

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“…Injections with botulinum toxin 27 and electrical stimulation 17 have both been used in efforts to reduce spasticity and, thus, improve finger function. Tendon releases and transfers have also been tried to mitigate the effects of muscle shortening and contracture.…”

mentioning

confidence: 99%

Quantitative features of the stretch response of extrinsic finger muscles in hemiparetic stroke

Kamper¹,

Rymer²

2000

Muscle Nerve

119

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Despite its potential importance in hand dysfunction, spasticity in the finger muscles following stroke has not been well described. To explore this area, we assessed the role of finger flexor spasticity, along with that of passive mechanical forces, in resisting finger movement in 13 chronic stroke subjects. Subjects were tested with a device that stretched the extrinsic finger muscles through imposed rotation of the metacarpophalangeal (MCP) joints. Both maintained and constant-velocity stretches were imposed. For the constant-velocity stretches, eight of the 13 stroke subjects exhibited strong stretch reflexes, as determined by electromyography and net work. The net work of this reflex response, calculated from the integral of the torque-angle plots, increased proportionally with increasing velocity, indicating a contribution from flexor muscle spasticity. Conversely, nine of the 13 stroke subjects did not possess distinctly greater passive, mechanical resistance to MCP rotation than control subjects. While extensor spasticity was not observed, stretch of the extrinsic finger flexors also produced some reflex activity in the finger extensors concomitant with reflex excitation of the flexors. These findings suggest that resistance to muscle stretching following stoke is mediated primarily by neurological rather than biomechanical disturbances, although changes in muscle fiber length may exaggerate the resistance.

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Botulinum toxin type A for the treatment of arm and hand spasticity in stroke patients

Abstract: Our study confirmed that BTX-A has an anti-spastic effect but its functional impact needs further evaluation.

Cited by 65 publications

References 8 publications

Is the Reduction of Spasticity by Botulinum Toxin A Beneficial for the Recovery of Motor Function of Arm and Hand in Stroke Patients?

Is the Reduction of Spasticity by Botulinum Toxin A Beneficial for the Recovery of Motor Function of Arm and Hand in Stroke Patients?

Efficacy of botulinum toxin A in upper limb function of hemiplegic patients

Quantitative features of the stretch response of extrinsic finger muscles in hemiparetic stroke

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