Post-Stroke Spasticity Management with Repeated Botulinum Toxin Injections in the Upper Limb

Lagalla, G.; Danni, Maura; Reiter, Frank; Ceravolo, Maria Gabriella; Provinciali, Leandro

doi:10.1097/00002060-200007000-00010

Cited by 101 publications

(55 citation statements)

References 21 publications

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“…51 Six uncontrolled studies have examined the effects of repeated injections. [57][58][59][60][61][62] These studies are summarised in Appendix 1, Table 36. Repeat injections decreased muscle tone by a similar amount after each injection and improved passive functional scores by a similar amount to the initial injection.…”

Section: Review Of the Evidence For Treating Upper Limb Spasticity Dumentioning

confidence: 99%

See 1 more Smart Citation

BoTULS: a multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A

Shaw

Rodgers²,

Price³

et al. 2010

Health Technol Assess

163

126

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on behalf of the BoTULS investigatorsHow to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address. Paying by credit cardYou can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume. How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeT he Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are...

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Section: Review Of the Evidence For Treating Upper Limb Spasticity Dumentioning

confidence: 99%

“…Repeat injections decreased muscle tone by a similar amount after each injection and improved passive functional scores by a similar amount to the initial injection. [58][59][60]62 Two studies measured active function 58,61 and one found improvement.…”

Section: Review Of the Evidence For Treating Upper Limb Spasticity Dumentioning

confidence: 99%

BoTULS: a multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A

Shaw

Rodgers²,

Price³

et al. 2010

Health Technol Assess

163

126

View full text Add to dashboard Cite

show abstract

“…1 Recent studies have reported that muscular injections of botulinum toxin type A decreases muscular tone in hypertonic muscles of the hand, with improvement in the use of the upper limb and a decrease in complications. [2][3][4][5] However, in a small number of patients, the development of neutralizing antibodies can reduce the efficacy of treatment. In addition, the dosage of botulinum is not always sufficient to treat extensive and severe hypertonia in upper and lower limbs.…”

mentioning

confidence: 99%

Long-Term Effect of Shock Wave Therapy on Upper Limb Hypertonia in Patients Affected by Stroke

Manganotti

Amelio

2005

Stroke

143

170

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Background and Purpose-Spasticity is a disabling complication of stroke and different noninvasive treatments are used to reduce muscle hypertonia. Shock waves are defined as a sequence of single sonic pulses largely used in the treatment of diseases involving bone and tendon as well as muscular contractures. The effect and duration of extracorporeal shock wave therapy (ESWT) was investigated on muscle hypertonia of the hand and wrist. Methods-A total of 20 patients affected by stroke associated with severe hypertonia in upper limbs were evaluated.Placebo stimulation was performed 1 week before active stimulation in each patient. Evaluation was performed using the National Institutes of Health and Ashworth scales and video monitoring with a digital goniometer before and immediately after placebo or active stimulation. Motor nerve conduction velocity from abductor digiti minimi were recorded. Patients were monitored at 1, 4, and 12 weeks after active treatment. Results-After active ESWT, patients showed greater improvement in flexor tone of wrist and fingers compared with placebo stimulation. At the 1-and 4-week follow-up visits, a significant decrease of passive muscle tonicity was noted on muscles in all patients receiving active treatment. At 12 weeks after therapy, 10 of the 20 patients showed persistent reduction in muscle tone. There were no adverse events associated with ESWT. Key Words: extracorporeal shock wave therapy Ⅲ muscle spasticity Ⅲ rehabilitation Ⅲ shock waves Ⅲ stroke I ncrease in muscle tone in the hands and wrists is a major problem in the management of chronic hemiparetic patients and may seriously impair dressing, washing, and other activities of daily living. 1 Motor neuron syndrome in stroke patients is a collection of symptoms including motor defects, increased reflexes, and muscle hypertonia, which produce a series of complications causing changes in the rheologic components of muscles and subsequent stiffness in tendons and joints. 1 In stroke, the hypertonia in muscles is partially related to spinal hyperexcitability in addition to fibrosis and changes in connective tissues that are responsible for passive rigidity of muscles. 1 Recent studies have reported that muscular injections of botulinum toxin type A decreases muscular tone in hypertonic muscles of the hand, with improvement in the use of the upper limb and a decrease in complications. [2][3][4][5] However, in a small number of patients, the development of neutralizing antibodies can reduce the efficacy of treatment. In addition, the dosage of botulinum is not always sufficient to treat extensive and severe hypertonia in upper and lower limbs. Rehabilitation and different noninvasive treatments, particularly on the connective components, should be also considered. Conclusions-ESWTShock waves are defined as a sequence of single sonic pulses characterized by high peak pressure (100 MPa), fast pressure rise (Ͻ10 ns), and short duration (10 s). Different studies and clinical experiments have demonstrated the efficacy of shock waves ...

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“…However, unlike botulinum toxin, no obvious weakness in the target muscle [34]. Chronic spasticity itself would further worsen joint resistance through fibrosis of inactive connective tissue due to structural and mechanical changes in the muscle [35]. So, reducing the stiffening of connective tissue caused by fibrosis of chronic hypertonic muscles would diminish spasticity [11].…”

Section: Methodsmentioning

confidence: 99%

“…Different treatment methods have been used for treatment of spasticity include physical therapy, oral anti-spastic drugs, chemical nerve block and motor point block using phenol or ethyl alcohol and botulinum toxin injection [5,6]. It has been reported that muscular injections of botulinum toxin type A decreases muscular tone in hypertonic muscles of the hand, with improvement in the use of the upper limb and a decrease in complications [7][8][9][10]. However, the development of neutralizing antibodies can reduce the efficacy of treatment.…”

mentioning

confidence: 99%

Effect of Different Energy Levels of Radial Shock Wave Therapy on Spasticity in Patients With Stroke

Fouda¹,

Mansour²

2018

IJPR

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Background and purpose: Spasticity in the hands and a wrist is a major problem in the management of stroke patients. Different energy levels of shock wave therapy (SWT) have been used for treatment of spasticity. So, the purpose of the study was to compare the effect of two different energy levels of radial SWT on spastic muscles of the hand and wrist in patients affected by stroke. Materials and Methods:Patients randomly assigned into two groups. Group A received the low energy radial SWT while group B received the medium energy radial SWT. Spasticity of wrist and fingers was evaluated using Modified Ashworth Scale (MAS), range of motion (ROM) of the wrist was evaluated using digital goniometer and pain was measured by Visual Analogue Scale (VAS).Results: there was a significant decrease in MAS scores of the wrist flexors and fingers flexors muscles post treatment for both groups (P<0.05). The ROM was significantly increased post treatment from (48.46±2.09) to (70.02±3.23) for group A and from (49.15±1.95) to (79.13±3.42) for group B. Also VAS scores was a significantly decreased in both groups post treatment. Conclusion:Radial SWT is an effective therapeutic tool in reducing flexor spasticity of the wrist and hand in patients with stroke. Moreover, the medium energy level was superior to the low energy level in regarding to the measured treatment outcomes.

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Post-Stroke Spasticity Management with Repeated Botulinum Toxin Injections in the Upper Limb

Abstract: This investigation is relevant clinically because repeated BTX-A injections show unchanging effectiveness in the management of focal spasticity after stroke.

Cited by 101 publications

References 21 publications

BoTULS: a multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A

BoTULS: a multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A

Long-Term Effect of Shock Wave Therapy on Upper Limb Hypertonia in Patients Affected by Stroke

Effect of Different Energy Levels of Radial Shock Wave Therapy on Spasticity in Patients With Stroke

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