Botulinum toxin for spasticity
Intramuscular injections of botulinum toxin A reduces spasticity of the wrist and finger muscles and associated disability in patients who have had a stroke.
Intramuscular injections of botulinum toxin A reduce spasticity of the wrist and finger muscles and associated disability in patients who have had a stroke.
Spasticity is a disabling complication of stroke, and whether or not intramuscular injections of botulinum toxin type A reduce this disability in persons with spasticity after a stroke is what the researchers at New England have studied. They assessed the efficacy and safety of one-time injections of botulinum toxin A (200 to 240 units) in 126 subjects with increased flexor tone in the wrist and fingers after a stroke. The primary outcome measure was self-reported disability in four areas: personal hygiene, dressing, pain, and limb position. Each subject selected one of these areas in which there was moderate-to-severe disability as the principal target of treatment.
Subjects who received botulinum toxin A had greater improvement in flexor tone in the wrist and fingers at all follow-up visits through 12 weeks than did subjects who received placebo. Subjects treated with it had greater improvement in the self-reported disability in any of four areas at weeks 4, 6, 8, and 12. There were no major adverse events associated with injection of botulinum toxin A. This large, multicenter, controlled study showed that in subjects with focal spasticity of the wrist and fingers due to a stroke, a single set of injections of botulinum toxin A into the spastic muscles resulted in significantly greater improvement in functional disability than did placebo injections. The toxin significantly reduced flexor muscle tone in the wrist, fingers, and thumb and improved the scores for both the physician's and the patient's or caregiver's global assessment.
The findings suggest that botulinum toxin A may be useful in improving flexor tone, functional disability, and quality of life in patients with spasticity of the fingers and wrist after a stroke.
The New England Journal of Medicine, August 2002, Vol. 347 (6)
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