Onabotulinumtoxin-A injection for disabling lower limb flexion in hemiplegic patients

Abstract

BACKGROUND: Hemiplegic patients with supraspinal spasticity can present with a flexor pattern at the hip and knee that hampers both passive and active functions. OBJECTIVE: To investigate the efficacy of OnabotulinumtoxinA injections on this flexor scheme. METHODS:This open-label observational study included eleven patients who had suffered a unilateral stroke or traumatic brain injury. All had impairment in the activities of daily living caused by severe hip and knee flexion. OnabotulinumtoxinA injections of 300-400U (total dose) were administered to the iliopsoas (iliacus) and knee flexors and, when necessary, to other muscles of the hip and knee. Evaluations were performed pre-treatment (weeks −4 to −8, and day 1) and post-treatment (week 10 and week 21): spasticity, range of motion, limb positioning, passive functions and pain. RESULTS: A modest improvement in hip and knee extension was observed, as evidenced by the Modified Ashworth Score and range of passive extension movements. Limb positioning was also improved. Clear benefits were found on passive functioning, including toileting, dressing and bed facilities, as well as pain levels. Active functions remained unchanged. More definite improvement was found in patients with severe difficulties. CONCLUSIONS: OnabotulinumtoxinA injection can contribute to reducing the consequences of disabling lower limb flexion.

Pain Reduction in Adults with Limb Spasticity Following Treatment with IncobotulinumtoxinA: A Pooled Analysis

“…At the time when the studies included in this analysis were conducted, there was a lack of instruments specifically for measuring spasticity-associated pain. Most studies used non-specific pain scales, including numeric rating scales [20,23,25,32,39,40] or visual analogue scales (the most validated outcome measure in pain) [24,26,28,29,41] with score ranges of 0-10; a few used the DAS [21,24,30,31]. Since then, an instrument specifically for measuring spasticity-associated pain has been developed (the Questionnaire on Pain caused by Spasticity [QPS]; [42]), and this was used in later pediatric studies.…”

“…The prevalence of pain among patients with limb spasticity varies widely from 46% to 74% depending on the patient population studied [19][20][21]. The efficacy of BoNT-A in reducing pain in patients with upper and lower limb spasticity has been investigated in clinical studies, either as a primary outcome [20][21][22][23][24][25] or a secondary outcome [12,14,15,17,[26][27][28][29][30][31][32][33][34][35]. These studies have involved cohorts with sizes varying from 11 patients [29] to 487 patients [23].…”

“…The efficacy of BoNT-A in reducing pain in patients with upper and lower limb spasticity has been investigated in clinical studies, either as a primary outcome [20][21][22][23][24][25] or a secondary outcome [12,14,15,17,[26][27][28][29][30][31][32][33][34][35]. These studies have involved cohorts with sizes varying from 11 patients [29] to 487 patients [23]. The pain-relief results have been conflicting, but many patients with limb spasticity report pain relief following BoNT-A injections.…”

Botulinum Toxin Injection-Site Selection for a Smooth Shoulder Line: An Anatomical Study

“…Poststroke spasticity [ 24 ] or hemiplegic cerebral palsy in children [ 25 ] involves problems with the upper flexor muscles. Supraspinal spasticity can present as disorders of the flexor pattern of the hips and knees [ 26 ]. Meanwhile, other clinical research has identified value of BTX for treating headaches, hypersalivation, hyperhidrosis, and other chronic conditions that respond only partially to medical treatment [ 1 ].…”

Botulinum toxin in treatment of lower limb spasticity in patients with brain damage

“…Точность введения БоНТ при спастичности достигается с помощью использования ультразвукового контроля [11,12]. При этом единого мнения о паттернах спастичности нижней конечности и методологии определения мышц-мишеней не выработано [13]. На сегодняшний день нет точных данных о частоте характерных паттернов при различной патологии и вероятности вовлечения в них разных мышц.…”