The Effectiveness of Botulinum Toxin Type A (BoNT-A) Treatment in Brazilian Patients with Chronic Post-Stroke Spasticity: Results from the Observational, Multicenter, Prospective BCause Study

Abstract

Botulinum toxin type A (BoNT-A) is an effective treatment for post-stroke spasticity; however, some patients cannot access treatment until ≥1 year post-stroke. This Brazilian post-marketing study (NCT02390206) assessed the achievement of person-centered goals in patients with chronic post-stroke spasticity after a BoNT-A injection. Patients had a last documented stroke ≥1 year before study entry and post-stroke upper limb (UL) spasticity, with or without lower limb (LL) spasticity. Patients received BoNT-A injections at baseline (visit 1) and visit 2 (3–6 months). Primary endpoint was responder rate (achievement of primary goal from Goal Attainment Scaling (GAS)) at visit 2. Overall, 204 patients underwent GAS evaluation at visit 2, mean (SD) age was 56.4 (13.2) years and 90.7% had LL spasticity. Median (range) time between first stroke and onset of spasticity was 3.6 (0−349) months, onset of spasticity and first injection was 22.7 (0−350) months and waiting time for a rehabilitation appointment was 9.0 (1−96) months. At visit 2, 61.3% (95% CI: 54.4, 67.7) of patients were responders, which was similar for UL and LL primary goals (57.8% [95% CI: 49.9, 65.3] vs. 64.1% [95% CI: 48.4, 77.3]). This study provides evidence to support the effectiveness of BoNT-A treatment for chronic post-stroke spasticity.

A UK Single-Center, Retrospective, Noninterventional Study of Clinical Outcomes and Costs of Two BotulinumtoxinA Treatments for Limb Spasticity

“…Clinical outcomes at Week 6, as measured by mean GAS-T scores, for patients injected with aboBoNT-A (47.8) or onaBoNT-A (43.1), were broadly consistent with those reported in previously published studies [ 8 , 9 , 23 , 24 ]. The GAS-T score informs on the accuracy of goal setting.…”

Intramuscular neural distribution of the teres minor muscle using Sihler’s stain: application to botulinum neurotoxin injection

“…The arborization patterns in the muscles were analyzed in relation to the vertical length of the muscle, which was divided into 5 parts. This division was based on previous studies that found botulinum neurotoxin to spread a few centimeters from the injection site [ 17 - 19 ].…”

A practical guide to botulinum neurotoxin treatment of teres major muscle in shoulder spasticity: Intramuscular neural distribution of teres major muscle in cadaver model

“…[2][3][4][5][6][7][8] Injection with botulinum toxin has been shown to improve shoulder function and reduce pain in an observational study of chronic poststroke spasticity. 9 However, no injection guidance for these muscles has been suggested.…”

“…Shoulder muscles have been included in clinical trials of botulinum toxin for upper limb spasticity and have demonstrated improvements 2–8 . Injection with botulinum toxin has been shown to improve shoulder function and reduce pain in an observational study of chronic poststroke spasticity 9 . However, no injection guidance for these muscles has been suggested.…”