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Post stroke spasticity, botulinum

Nataliia Chemer, Volodymyr Bilanovskyi
INTRODUCTION: Recent studies show that spasticity occurs in 20-30% of all stroke victims, especially in younger patients. Botulinum toxin is a very effective treatment; however, it is not reimbursed in the Ukraine, thus leaving patients untreated and unable to use the paralyzed limb. Finally, this might result in long-term disability with economic consequences and negative impact on the psychological state of patients. Therefore, alternative and affordable treatment options are of high interest...
February 18, 2019: Neurology and Therapy
Andrea Santamato, Nicoletta Cinone, Francesco Panza, Sara Letizia, Luigi Santoro, Madia Lozupone, Antonio Daniele, Alessandro Picelli, Alessio Baricich, Domenico Intiso, Maurizio Ranieri
Post-stroke lower limb spasticity impairs balance and gait leading to reduced walking speed, often increasing wheelchair use and caregiver burden. Several studies have shown that appropriate treatments for lower limb spasticity after stroke include injections of botulinum toxin type A (BoNT-A), phenol or alcohol, surgical correction and a rehabilitation program. In the present article, we review the safety and effectiveness of BoNT-A for the treatment of lower limb spasticity after stroke, with a focus on higher doses of BoNT-A...
February 2019: Drugs
Babak Afsharipour, Sourav Chandra, Jongsang Son, William Z Rymer, Nina L Suresh
Botulinum toxin (BT) is widely prescribed by physicians for managing spasticity post stroke. In an ongoing study, we examine the spatial pattern of muscle activity in biceps brachii of stroke survivors before and after receiving BT, examined over the course of 11 weeks (2 weeks before - 9 weeks after). We hypothesize that BT alters muscle electrophysiology by disrupting fiber neuromuscular transmission in an inhomogeneous manner and we seek to detect these changes using grid surface electromyography (sEMG)...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
A P Kovalenko, V K Misikov
AIM: To develop and test a method of examination of patients with lower limb spasticity, to describe lower limb spasticity patterns in patients with brain damage and to assess the efficacy of abobotulinumtoxin A (dysport) in the rehabilitation of patients with stroke. MATERIAL AND METHODS: Spasticity rating scales (MAS and Tardieu), the Barthel index, the Rankin scale , the Rivermead Mobility Index, the Hauser Ambulation Index, a comfortable walking test were used...
2018: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
K Fheodoroff, D Dressler, H Woldag, P Koßmehl, M Koch, P Maisonobe, G Reichel
BACKGROUND: The ULIS-II was an international cohort study (NCT01020500) evaluating current treatment of upper limb spasticity in post-stroke adult patients with botulinum toxin A (BoNT-A) in real-life practice. OBJECTIVE: Post hoc analysis to compare current management of post-stroke adult patients regarding goal setting and attainment with BoNT-A in Germany (D) and Austria (A) with the full cohort of ULIS-II. MATERIAL AND METHODS: The ULIS-II was a global, open-label, prospective, multicenter observational study with 2 visits conducted in 84 centers worldwide...
October 15, 2018: Der Nervenarzt
Alessio Baricich, Alessandro Picelli, Andrea Santamato, Stefano Carda, Alessandro de Sire, Nicola Smania, Carlo Cisari, Marco Invernizzi
Botulinum toxin type A (BoNT-A) is considered the gold standard for the treatment of focal post-stroke spasticity (PSS). However, a recently published study estimated that a significant percentage of patients affected by PSS could benefit from higher doses of BoNT-A than those permitted by current directives in the countries studied. Several studies have reported the use of high doses of BoNT-A in the management of patients affected by severe PSS; however, the most important adverse effect of this drug might be systemic diffusion of the toxin, which could potentially be related to its dose...
September 12, 2018: Clinical Drug Investigation
Isil Fazilet Turna, Belgin Erhan, Necibe Berrin Gunduz, Onder Turna
The purpose of this study was to compare the effects of different injection technique guidance with electrical stimulation (ES) vs ultrasonography (USG) of botulinum toxin A injection (BoNT A) in post-stroke patients with plantar flexor spasticity. Forty chronic post-stroke patients with plantar flexor spasticity and who were able to walk were included in the study. They were randomized into two groups: in 20 patients the BoNT A injection was applied with the guidance of ES and in 20 patients with the guidance of USG by the same physician...
July 5, 2018: Acta Neurologica Belgica
Ruoli Wang, Johan Gäverth, Pawel A Herman
Quantifying neural and non-neural contributions to the joint resistance in spasticity is essential for a better evaluation of different intervention strategies such as botulinum toxin A (BoTN-A). However, direct measurement of muscle mechanical properties and spasticity-related parameters in humans is extremely challenging. The aim of this study was to use a previously developed musculoskeletal model and optimization scheme to evaluate the changes of neural and non-neural related properties of the spastic wrist flexors during passive wrist extension after BoTN-A injection...
2018: Frontiers in Bioengineering and Biotechnology
Koji Makino, Dominic Tilden, Carmel Guarnieri, Mia Mudge, Ian J Baguley
BACKGROUND: In Australia, the reimbursement of botulinum neurotoxin-A (BoNT-A) on the Pharmaceutical Benefits Scheme for the treatment of moderate to severe spasticity of the upper limb following a stroke (PSS-UL) is restricted to four treatment cycles per upper limb per lifetime. This analysis examined the cost effectiveness of extending the treatment beyond four treatments among patients with an adequate response to previous treatment cycles. METHODS: A Markov state transition model was developed to perform a cost-utility analysis of extending the use of incobotulinumtoxin-A beyond the current restriction of four treatment cycles among patients who have shown a successful response in previous treatment cycles ('known responders')...
June 18, 2018: PharmacoEconomics Open
Jihye Park, Myung Eun Chung
Botulinum toxin (BTX) is widely used to treat muscle spasticity by acting on motor neurons. Recently, studies of the effects of BTX on sensory nerves have been reported and several studies have been conducted to evaluate its effects on peripheral and central neuropathic pain. Central neuropathic pain includes spinal cord injury-related neuropathic pain, post-stroke shoulder pain, multiple sclerosis-related pain, and complex regional pain syndrome. This article reviews the mechanism of central neuropathic pain and assesses the effect of BTX on central neuropathic pain...
June 1, 2018: Toxins
Dursun Erbil, Gokbel Tugba, Topcu Hasan Murat, Akarsu Melike, Akyüz Merve, Karacan Cagla, Çiftçi Can Mehmetali, Öztürk Akay, Dursun Nigar
OBJECTIVE: To investigate combined effects of robot-assisted training (RAT) and physical therapy versus physical therapy only on balance and gait function of chronic stroke patients after botulinum toxin-A (BoNT-A) treatment. METHODS: Forty-eight chronic stroke patients, received BoNT-A treatment for lower extremity spastic muscles, were randomly assigned to RAT (n = 32) and control (n = 16) groups in a 2:1 ratio. RAT group received 30 min of RAT (RoboGait®) plus 60 min of physical therapy, whereas controls received 90 min of physical therapy for 3 weeks during weekdays...
July 2018: Physiotherapy Research International: the Journal for Researchers and Clinicians in Physical Therapy
Natasha A Lannin, Louise Ada, Tamina Levy, Coralie English, Julie Ratcliffe, Doungkamol Sindhusake, Maria Crotty
Background: Botulinum toxin-A is provided for adults with post-stroke spasticity. Following injection, there is a variation in the rehabilitation therapy type and amount provided. The purpose of this study was to determine if it is feasible to add intensive therapy to botulinum toxin-A injections for adults with spasticity and whether it is likely to be beneficial. Methods: Randomized trial with concealed allocation, assessor blinding, and intention to treat analysis...
2018: Pilot and Feasibility Studies
Keng He Kong, Jovita Balcaitiene, Hugues Berard, Pascal Maisonobe, Khean Jin Goh, Witsanu Kumthornthip, Raymond L Rosales
Introduction: Approximately 15 million people suffer a stroke annually, up to 40% of which may develop spasticity, which can result in impaired limb function, pain and associated involuntary movements affecting motor control.Robust clinical data on spasticity progression, associated symptoms development and functional impairment is scarce. Additionally, maximal duration of muscle tone reduction following botulinum toxin type A (BoNT-A) injections remains undetermined. The ONTIME pilot study aims to explore these issues and evaluate whether abobotulinumtoxinA 500 U (Dysport® ; Ipsen) administered intramuscularly within 12 weeks following stroke delays the appearance or progression of symptomatic (disabling) upper limb spasticity (ULS)...
June 2017: Contemporary Clinical Trials Communications
Semra Aktürk, Raikan Büyükavcı, Yüksel Ersoy
OBJECTIVE: The aim of this study is to identify the effect on spasticity and walking of US-guided botulinum toxin type A (BoNT-A) injections administered to improve equinovarus walking pattern commonly observed in patients after stroke. MATERIAL AND METHOD: Twenty-three patients with post-stroke spastic equinovarus deformity were recruited. The US-guided BoNT-A injections were administered into the spastic muscles (including gastrocnemius; GK, soleus; S and tibialis posterior; TP) using a specific approach, and all of the patients were enrolled in rehabilitation programmes after the injections...
May 2018: Toxicon: Official Journal of the International Society on Toxinology
Hyun-Mi Oh, Geun-Young Park, Young Min Choi, Hyung Jung Koo, Yongjun Jang, Sun Im
BACKGROUND: There are no guidelines on the ideal time to inject botulinum toxin type A (BT-A) for lower leg spasticity in stroke patients. An early injection may produce unwanted weakness, interfering with gait recovery. OBJECTIVE: To evaluate whether the outcomes after BT-A injection for plantarflexion spasticity can be different according to stroke chronicity. DESIGN: A secondary analysis study from a double-blinded, randomized trial with group reclassification according to stroke chronicity...
August 2018: PM & R: the Journal of Injury, Function, and Rehabilitation
Raikan Buyukavci, Semra Akturk, Yüksel Ersoy
BACKGROUND: Ultrasound-guided botulinum toxin type A injection is an effective treatment for spasticity. Euro-musculus spasticity approach is a new method for administering injections to the correct point of the correct muscle. The clinical outcomes of this practical approach are not yet available in the literature. AIM: The purpose of this study was to evaluate the effects on spasticity and the functional outcomes of ultrasound guided botulinum toxin type A injections via the Euro-musculus spasticity approach to treat upper limb spasticity in post-stroke patients...
October 2018: European Journal of Physical and Rehabilitation Medicine
Maria Pais de Carvalho, Daniela Pinto, Melissa Gorayeb, Jorge Jacinto
Background Botulinum toxin type-A (BoNTA) is a recognized treatment for upper limb spasticity (ULS) after stroke, but there aren't many studies analyzing its effect in shoulder muscles. Objective To evaluate the efficacy of BoNTA injections for ULS, when shoulder muscles are included. Methods A cross-sectional study. Data from clinical forms of outpatients, treated at a Rehabilitation Center (2001-2016). Analyzes: goals of treatment; demographic characteristics/goal; treatment success, using Goal Attainment Scaling...
April 2018: Topics in Stroke Rehabilitation
Anupam Datta Gupta, Wing Hong Chu, Stuart Howell, Subhojit Chakraborty, Simon Koblar, Renuka Visvanathan, Ian Cameron, David Wilson
BACKGROUND: Improved walking is one of the highest priorities in people living with stroke. Post-stroke lower limb spasticity (PSLLS) impedes walking and quality of life (QOL). The understanding of the evidence of improved walking and QOL following botulinum toxin (BoNTA) injection is not clear. We performed a systematic review of the randomized control trials (RCT) to evaluate the effectiveness of BoNTA injection on walking and QOL in PSLLS. METHODS: We searched PubMed, Web of Science, Embase, CINAHL, ProQuest Thesis and Dissertation checks, Google Scholar, WHO International Clinical Trial Registry Platform, ClinicalTrials...
January 5, 2018: Systematic Reviews
Alessandro Picelli, Alessio Baricich, Elena Chemello, Nicola Smania, Carlo Cisari, Marialuisa Gandolfi, Nicoletta Cinone, Maurizio Ranieri, Andrea Santamato
The tibialis posterior muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the tibialis posterior muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the tibialis posterior muscle in chronic stroke patients with spastic equinovarus foot...
November 18, 2017: Toxins
Richard J Holmes, Louise A Connell
PURPOSE: To describe the current UK practice for the use of intramuscular Botulinum Toxin type A injections to treat hemiplegic shoulder pain. METHOD: A UK-based cross-sectional study using an online survey. Participants (n = 68) were medical and non-medical practitioners recruited via the membership of the British Society for Rehabilitation Medicine and the British Neurotoxin Network. Data was analysed using descriptive statistics and content analysis. RESULTS: The majority of respondents would consider Botulinum Toxin type A for hemiplegic shoulder pain (86...
November 10, 2017: Disability and Rehabilitation
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