Can the early use of botulinum toxin in post stroke spasticity reduce contracture development? A randomised controlled trial

Abstract

Objective: Does early treatment of spasticity with botulinum-toxin (BoNTA), in (hyper)acute stroke patients without arm-function, reduce contractures and improve function. Design: Randomised placebo-controlled-trial Setting: Specialised stroke-unit. Participants & Intervention: Patients with an Action Research Arm Test (ARAT) grasp-score⩽2 who developed spasticity within six-weeks of a first stroke were randomised to receive injections of: 0.9%sodium-chloride solution (placebo) or onabotulinumtoxin-A (treatment). Outcome-Measures: Spasticity, contractures, splint use and arm function (ARAT) were taken at baseline, 12-weeks post-injection and six-months after stroke. Additionally, spasticity and contractures were measured at weeks-two, four and six post-injection. Results: Ninety three patients were randomised. Mean time to intervention was 18-days (standard deviation = 9.3). Spasticity was lower in the treatment group with difference being significant between week-2 to 12 (elbow) and week-2 to 6 (wrist). Mean-difference (MD) varied between –8.5(95% CI –17 to 0) to –9.4(95% CI –14 to –5) µV. Contracture formation was slower in the treatment group. Passive range of motion was higher in the treatment group and was significant at week-12 (elbow MD6.6 (95% CI –0.7 to –12.6)) and week-6 (wrist MD11.8 (95% CI 3.8 to 19.8)). The use of splints was lower in the treatment group odds ratio was 7.2 (95% CI 1.5 to 34.1) and 4.2 (95% CI 1.3 to 14.0) at week-12 and month-6 respectively. Arm-function was not significantly different between the groups MD2.4 (95% CI –5.3 to 10.1) and 2.9 (95% CI –5.8 to 11.6) at week-12 and month-6 respectively. Conclusion: BoNTA reduced spasticity and contractures after stroke and effects lasted for approximately 12-weeks. BoNTA reduced the need for concomitant contracture treatment and did not interfere with recovery of arm function. Trial Registration: EudraCT (2010-021257-39) and ClinicalTrials.gov-Identifier: NCT01882556.

Early Botulinum Toxin Type A Injection for Post-Stroke Spasticity: A Longitudinal Cohort Study

“…Botulinum toxin type A (BoNT-A) is a recommended treatment for PSS [ 10 , 11 , 12 ]. Despite the growing evidence for early treatment of PSS [ 13 , 14 , 15 ], BoNT-A is usually administered to chronic stroke patients in routine clinical practice [ 16 , 17 ], probably because of the variable prevalence of PSS during the first year after onset and because the published literature about BoNT-A for PSS reports mainly on treatment during the chronic phase [ 3 ]. With this study, we wanted to determine whether the time between stroke onset and initial BoNT-A injection had an effect on outcomes after treatment for PSS in routine clinical practice.…”

Early Use of Phenol Neurolysis Likely Reduces the Total Amount of Botulinum Toxin in Management of Post-Stroke Spasticity

“…Similarly, in our retrospective study (12), we found that stroke survivors who received BoNT injections at an earlier time had much longer lasting effects than those who received injections at a late date. Taken together, these studies have supported the benefits of early spasticity intervention after stroke (5,(13)(14)(15)(16)(17)(18)(19).…”

Comprehensive Assessment of the Time Course of Biomechanical, Electrophysiological and Neuro-Motor Effects after Botulinum Toxin Injections in Elbow Flexors of Chronic Stroke Survivors with Spastic Hemiplegia: A Cross Sectional Observation Study

“…In contrast, passive torques were significantly higher and passive range of motion of wrist and finger extension was significantly smaller in the affected limb than the contralateral limb in those who received BoNT injections to these muscles, on average, 4 and 1/2 years ago [43]. In another study [44], stroke subjects received either BoNT or placebo (normal saline) injections when spasticity was first detected in the arm flexors. The mean time to injections was 18 days after stroke.…”