Intramuscular Injection of Botulinum Toxin for the Treatment of Wrist and Finger Spasticity after a Stroke

Brashear, Allison; Gordon, Mark Forrest; Elovic, Elie P.; Kassicieh, V. Daniel; Marciniak, Christina; Do, Mai; Lee, Chia Ho; Jenkins, Stephen; Turkel, Catherine C.

doi:10.1056/nejmoa011892

Cited by 514 publications

(418 citation statements)

References 17 publications

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“…From the 98 selected papers, six fulfilled all inclusion criteria [8][9][10][11][12][13] . Despite one study 8 presented the described criteria, it was excluded from the metaanalysis because it did not present comparable data to be analysed ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The spasticity is variable from patient to patient and individualised scales will be necessary to measure specific goals 14 . Brashear et al 13 analysed functional aspects of post-stroke patients with wrist and finger spasticity submitted to intra-muscular injection of BTX-A or placebo. These authors observed significant improvement of functional disability in pa- tients that received BTX-A when compared to placebo group, emphasising the importance of BTX-A in clinical rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

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Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: a meta-analysis

Cardoso

Rodrigues

Lucena

et al. 2005

Arq. Neuro-Psiquiatr.

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Muscle over-activity is one of the cardinal features of spasticity and it is a common disability of stroke patients. In this group, spasticity is responsible for several limitations that interfere in their daily activities and quality of life. To treat spasticity, neurologists usually prescribe drugs as baclofen, tizanidine or benzodiazepines or even use definitive treatment as phenol or surgery. Authors suggest the use of botulinum toxin type A (BTX-A) for spasticity in the upper limbs after stroke, but there are few papers with adequate methodology supporting this idea. In this article we summarize the data of previous double-blind, randomised clinical trials to asses, with a meta-analysis, if BTX-A is an adequate treatment for spasticity due to stroke. The results show a statistical superiority of BTX-A ov%r placebo on reducing muscle tone by the Modified Ashworth Scale (WMD= 0.95 [0.74 to 1.17]) in patients with post-stroke upper limb spasticity.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: a meta-analysis

Cardoso

Rodrigues

Lucena

et al. 2005

Arq. Neuro-Psiquiatr.

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show abstract

“…Contracture and change in the morphologic features of muscle 36 contribute to a flexed posture, but poor motor control with weakness, not hypertonia, is the primary cause of disability. 37 In a randomized trial, the injection of botulinum toxin into the muscles of the arm reduced excessive flexion and the associated pain, spasms, or postures that interfered with patients' self-care, 38 but the induced muscle weakness usually does not improve the functional use of the hand. The injection must be followed by stretching exercises and treatment of pain that may exacerbate the hypertonicity.…”

Section: Targeted Therapymentioning

confidence: 99%

Rehabilitation after Stroke

2005

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A 66-year-old man was suddenly unable to speak, follow directions, or move his right arm and leg. He received tissue plasminogen activator within 90 minutes. Four days later, his speech was limited to effortful answers of yes or no. He could not walk or use his right arm, and self-care tasks required maximal assistance. What advice would you offer him and his family regarding rehabilitation for his disabilities? THE CLINICAL PROBLEMApproximately 400 persons per 100,000 population over the age of 45 years have a first stroke each year in the United States, Europe, and Australia. Stroke is the most frequent cause of adult-onset disability among people in the United States, and the cost of related care is among the fastest-growing expenses for Medicare. 1 The likelihood of improvement after stroke varies with the nature and severity of the initial deficit. Approximately 35 percent of survivors with initial paralysis of the leg do not regain useful function, and 20 to 25 percent of all survivors are unable to walk without full physical assistance. 2 Six months after stroke, about 65 percent of patients cannot incorporate the affected hand into their usual activities. Poor upper-extremity outcomes are probable after a hemispheric infarction when the leg cannot move by two weeks and the hand has no movement or only slight finger flexion with no opening by four weeks, consistent with considerable damage to the corticospinal tract. 3 Patients who survive a stroke almost always have less physical disability by the end of the first three months. Functional scales, such as the Barthel Index and the Functional Independence Measure (which measure the physical assistance or supervision needed for self-care, including using the toilet, dressing, bathing, eating, and mobility), tend to show a plateau of gains by three to four months after stroke, partly owing to insensitivity of the scale to further improvements. Patients who no longer require assistance at that point may still be unable to use the affected hand, walk at speeds and distances that permit activities outside the home, or live alone. Only 25 percent of patients return to the level of everyday participation and physical functioning of community-matched persons who have not had a

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“…Seven BoNT serotypes are known to exist (A-G), all of which are produced by strains of the bacterium Clostridium botulinum. BoNT causes the paralytic syndrome botulism, but also holds therapeutic application in the treatment of dystonias [3][4][5][6], spasticity [7,8], facial rhytides [9], axillary hyperhidrosis [10,11], and some pain syndromes [12,13].…”

Section: Introductionmentioning

confidence: 99%

Proteomic changes in rat thyroarytenoid muscle induced by botulinum neurotoxin injection

et al. 2008

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Botulinum neurotoxin (BoNT) injection into the thyroarytenoid (TA) muscle is a commonly performed medical intervention for adductor spasmodic dysphonia. The mechanism of action of BoNT at the neuromuscular junction is well understood, however, aside from reports focused on myosin heavy chain isoform abundance, there is a paucity of data addressing the effects of therapeutic BoNT injection on the TA muscle proteome. In this study, 12 adult Sprague Dawley rats underwent unilateral TA muscle BoNT serotype A injection followed by tissue harvest at 72 hrs, 7 days, 14 days, and 56 days post-injection. Three additional rats were reserved as controls. Proteomic analysis was performed using 2D SDS-PAGE followed by MALDI-MS. Vocal fold movement was significantly reduced by 72 hrs, with complete return of function by 56 days. Twenty-five protein spots demonstrated significant protein abundance changes following BoNT injection, and were associated with alterations in energy metabolism, muscle contractile function, cellular stress response, transcription, translation, and cell proliferation. A number of protein abundance changes persisted beyond the return of gross physiologic TA function. These findings represent the first report of BoNT induced changes in any skeletal muscle proteome, and reinforce the utility of applying proteomic tools to the study of system-wide biological processes in normal and perturbed TA muscle function.

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Intramuscular Injection of Botulinum Toxin for the Treatment of Wrist and Finger Spasticity after a Stroke

Abstract: Intramuscular injections of botulinum toxin A reduce spasticity of the wrist and finger muscles and associated disability in patients who have had a stroke.

Cited by 514 publications

References 17 publications

Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: a meta-analysis

Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: a meta-analysis

Rehabilitation after Stroke

Proteomic changes in rat thyroarytenoid muscle induced by botulinum neurotoxin injection

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