Low-Dose Botulinum Toxin with Short-Term Electrical Stimulation in Poststroke Spastic Drop Foot

Bayram, Suheda; Sivrioğlu, Konçuy; Karlı, Necdet; Özcan, Orhan

doi:10.1097/01.phm.0000193505.85874.61

Cited by 61 publications

(62 citation statements)

References 27 publications

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“…12 The current results are also consistent with a previous study demonstrating that increased efficacy of BTX-A when associated with electrical stimulation could result in the use of a decreased dose, as there was no difference in the effectiveness between low dose BTX-A (100 units) combined with short-term stimulation and high-dose (400 units) application in spastic drop foot. 1 The use of a short 20-minute session of manipulation after NT injection is easier and more acceptable to patients compared with the various electrical stimulation paradigms. Additionally, passive stretch has an advantage over active muscle contraction and electrical stimulation, both of which are uncomfortable.…”

Section: Figure 6: Muscle Fiber Area Measured In Botulinum Toxin a (Bmentioning

confidence: 99%

“…[1][2][3] Therapeutic effects of NT treatment on spasticity include improved muscle function, facilitation of the effects of physical therapy, and delayed surgery. However, there are immediate and long-term negative side effects related to NT treatments, including systemic weakness and resistance to the toxin.…”

mentioning

confidence: 99%

“…[4][5][6] It is suggested that NT side effects are dose-dependent. 1,7 Efforts have been made to identify factors that might improve the effectiveness of this class of drugs, as increased efficacy may result in lower utilized doses, reduced costs, and potentially, longer-lasting treatment effects.…”

mentioning

confidence: 99%

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Increased efficacy and decreased systemic‐effects of botulinum toxin A injection after active or passive muscle manipulation

Minamoto

Hulst²,

Lim³

et al. 2007

Develop Med Child Neuro

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The effect of physical manipulation on the outcome of neurotoxin (NT) injection was studied in a rat tibialis anterior (TA) model system where dorsiflexion torque could be measured precisely. After determination of initial torque, all rats received a one-time botulinum toxin A (BTX-A) injection (dose 6.0 units/kg in a volume of 100μL) into the TA midbelly. Four experimental groups were studied: one group was subjected to BTX-A injection alone (BTX-A only, n=8), one was subjected to BTX-A injection followed immediately by 10 isometric contractions (ISO; n=9), and the third was subjected to BTX-A followed immediately by 10 muscle passive stretch/release cycles (PS; n=10). After 1 month, maximum dorsiflexion torque of the injected and contralateral legs was determined followed by quantification of TA fiber area. Post-injection torque was significantly reduced by around 80% in all NT-treated extremities 1 month after injection (p<0.05). While all NT-treated extremities demonstrated a significant torque decrease relative to their pre-injection levels, ISO and PS groups demonstrated significantly lower torques compared with the BTX-A only group which received no physical manipulation (p<0.05) indicating greater efficacy. Perhaps even more surprising was that the ISO and PS groups both demonstrated a significantly smaller contralateral effect compared with the BTX-A only group that received no manipulation (p<0.05) indicating a decreased systemic-effect. Muscle fiber size generally correlated with dorsiflexion torque. These data demonstrate that both neuromuscular activity (seen in the ISO group) and muscle movement (seen in the PS group) increased the efficacy of BTX-A and decreased the systemic side effects.Neurotoxins (NT) that block neuromuscular transmission are used to treat muscular spasticity secondary to cerebral palsy, stroke, and head injury. 1-3 Therapeutic effects of NT treatment on spasticity include improved muscle function, facilitation of the effects of physical therapy, and delayed surgery. However, there are immediate and long-term negative side effects related to NT treatments, including systemic weakness and resistance to the toxin. [4][5][6]

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Section: Figure 6: Muscle Fiber Area Measured In Botulinum Toxin a (Bmentioning

confidence: 99%

mentioning

confidence: 99%

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Increased efficacy and decreased systemic‐effects of botulinum toxin A injection after active or passive muscle manipulation

Minamoto

Hulst²,

Lim³

et al. 2007

Develop Med Child Neuro

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show abstract

“…The reduction in spasticity in the last phases of the evaluation was expected based on results from previous studies in patients with stroke 28 and cerebral palsy 29,30 . The use of BTXA reduces lower-limb spasticity in several conditions involving pyramidal system injury, including stroke 6,28 .…”

mentioning

confidence: 99%

Effects of botulinum toxin type A for spastic foot in post-stroke patients enrolled in a rehabilitation program

Pimentel

Alencar²,

Rodrigues³

et al. 2014

Arq. Neuro-Psiquiatr.

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The objective of this study was to evaluate the effects of botulinum toxin type A (BTX-A) on spastic foot in stroke patients in a rehabilitation program. Method: Hemiparetic stroke patients (n=21) enrolled in a rehabilitation program were divided into two groups. The first group (n=11) received a total of 300UI BTX-A, and the second group (n=10) received 100 UI BTX-A. All patients were assessed at baseline and 2, 4, 8 and 12 weeks after injection for Modified Ashworth Score, time walking 10 meters, and the Functional Independence Measure (mFIM) motor score. Results: The higher-dose group exhibited a significant improvement in spasticity, and both groups showed an improvement in time walking 10 meters and mFIM, with no significant differences between them. Conclusions: Our findings suggest that gains in gait velocity and functional independence were not correlated to BTX-A dose.Keywords: botulinum toxin type A, stroke, spasticity. RESUMOO objetivo deste estudo foi avaliar os efeitos da toxina botulínica tipo A (TXB-A) sobre a espasticidade de membro inferior em pacientes pós-AVE em reabilitação. Método: 21 pacientes hemiparéticos foram divididos em dois grupos que receberam doses de TXB-A de 300UI (Grupo 1) e 100UI (Grupo 2) e foram avaliados antes da injeção e 2, 4, 8 e 12 semanas após, quanto à escala de Ashworth modificada, tempo para andar 10 metros e escore motor da Medida de Independência Funcional (MIFm). Resultados: O grupo que utilizou dose mais alta teve melhora significativa da espasticidade. Ambos os grupos tiveram melhora do tempo para andar 10 metros e da MIFm sem diferença significativa entre eles. Conclusões: A melhora da velocidade de marcha e da independência funcional não foram correlacionadas com a dose de TXB-A na amostra analisada.Palavras-chave: toxina botulínica tipo A, acidente vascular cerebral, espasticidade.

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“…58 Improvement has been recorded in both groups, while this preliminary single-blind study was unable to find a difference in terms of effectiveness between the two treatment groups. Randomized controlled trials investigating safety and Table 2.…”

Section: Btx For Lower Limb Spasticitymentioning

confidence: 96%

Botulinum Toxin in Poststroke Spasticity

Özçakır

Sivrioğlu²

2007

Clinical Medicine & Research

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Poststroke hemiparesis, together with abnormal muscle tone, is a major cause of morbidity and disability. Although most hemiparetic patients are able to reach different ambulatory levels with rehabilitation efforts, upper and lower limb spasticity can impede activities of daily living, personal hygiene, ambulation and, in some cases, functional improvement.The goals of spasticity management include increasing mobility and range of motion, attaining better hygiene, improving splint wear and other functional activities. Conservative measures, such as positioning, stretching and exercise are essential in spasticity management, but alone often are inadequate to effectively control it. Oral antispastic medications often provide limited effects with short duration and frequent unwanted systemic side effects, such as weakness, sedation and dry mouth.Therefore, neuromuscular blockade by local injections have become the first choice for the treatment of focal spasticity, particularly in stroke patients. Botulinum toxin (BTX), being one of the most potent biological toxins, acts by blocking neuromuscular transmission via inhibiting acetylcholine release. Currently, focal spasticity is being treated successfully with BTX via injecting in the spastic muscles.Two antigenically distinct serotypes of BTX are available on the market as type A and B. Clinical studies of BTX used for spastic hemiplegic patients are reviewed in this article in two major categories, upper and lower limb applications. This review addresses efficacy in terms of outcome measures, such as muscle tone reduction and functional outcome, as well as safety issues. Application modifications of dose, dilutions, site of injections and combination therapies with BTX injections are also discussed.

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Low-Dose Botulinum Toxin with Short-Term Electrical Stimulation in Poststroke Spastic Drop Foot

Abstract: Our preliminary single-blind study was unable to find a difference in terms of effectiveness between low-dose (100 units) botulinum toxin combined with short-term electrical stimulation and high-dose (400 units) application in spastic drop foot.

Cited by 61 publications

References 27 publications

Increased efficacy and decreased systemic‐effects of botulinum toxin A injection after active or passive muscle manipulation

Increased efficacy and decreased systemic‐effects of botulinum toxin A injection after active or passive muscle manipulation

Effects of botulinum toxin type A for spastic foot in post-stroke patients enrolled in a rehabilitation program

Botulinum Toxin in Poststroke Spasticity

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