Abstract | BACKGROUND AND PURPOSE: Three-dimensional movement in the upper limb presents a challenge for functional management of regional spasticity. Potential toxicity of botulinum toxin limits the number of muscles which may be injected in any one session. Serial injection may offer a solution, but carries theoretical risk of development of resistance due to antibody formation. This article reviews a small case series, gathered in a post-acute neuro-rehabilitation setting, to evaluate the use of serial botulinum toxin injection in terms of goal achievement and clinical evidence for toxicity or resistance. METHODS: Nine patients with regional spasticity following acute stroke or brain injury had serial injection of botulinum toxin to muscle groups around the shoulder, elbow and/or wrist. Injection was followed by splinting/physiotherapy as appropriate. Goal attainment scaling was used to assess outcome. RESULTS: Functional goals achieved were reduction of pain (n=6/7) associated reaction (n=4/5) or care needs (n=5/6), improved gait (n=2/3) or independence in self-care (n=2/5). Two 'golden responder' cases are presented in detail to demonstrate resolution of symptoms with up to four serial injections of botulinum toxin over a period of up to 6 months. No clinical evidence of toxicity or resistance was seen in any case. CONCLUSION: These preliminary findings suggest that serial botulinum toxin injection followed by appropriate physiotherapy/splinting may provide effective treatment for regional spasticity. Resistance has not presented a problem in this post-acute situation, where treatment has not been required beyond a few months. Ongoing evaluation is underway.
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Authors | Lynne Turner-Stokes, Stephen Ashford |
Journal | Disability and rehabilitation
(Disabil Rehabil)
Vol. 29
Issue 23
Pg. 1806-12
(Dec 15 2007)
ISSN: 0963-8288 [Print] England |
PMID | 18033605
(Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't, Review)
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Chemical References |
- Neuromuscular Agents
- Botulinum Toxins, Type A
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Topics |
- Adult
- Arm
- Botulinum Toxins, Type A
(administration & dosage)
- Brain Injuries
(rehabilitation)
- Gait
(drug effects)
- Humans
- Male
- Muscle Spasticity
(physiopathology)
- Muscle, Skeletal
(physiopathology)
- Neuromuscular Agents
(therapeutic use)
- Pain Measurement
- Physical Therapy Modalities
- Retreatment
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