The efficacy of Botulinum Toxin A in poststroke spasticity

Abstract

To assess the efficacy of the Botulinum Toxin A (BTX-A) on spasticity, motor evaluation, function and quality of life in patients with spasticity of upper and lower extremity following hemiplegia. Spasticity was assessed with Modified Ashworth Scale (MAS), motor function of upper and lower extremities and hand of hemiplegic side were evaluated with Brunnstrom neurophysiologic evaluation, mobilization was assessed with Rivermead Motor Assessment (RMA), upper extremity function was evaluated with Fugl Meyer (FM), functional assesment was evaluated with Functional Independence Measure (FIM), quality of life was assessed with Short Form 36 (SF-36) at baseline and at week 6. Sixteen patients (4 right hemiplegia, 12 left hemiplegia) with mean age of 47.56±17.2 years were included. BTX-A was injected into the forearm flexors in 7 cases, pronators in 6 cases, wrist flexors in 6 cases, finger flexors in 10 cases, and ankle flexors in 8 cases with a total dose of 300 U for each case. Significant improvements were detected for MAS of all muscles which were BTX-A injected compared to pretreatment. Significant improvements were detected for Brunnstrom evaluation of hand, RMA, FM and FIM compared to pretreatment. While significant improvement was found for only role limitations due to physical problems subgroup of SF-36, there was no statistical difference for other subgroups. Botulinum toxin A is safe regarding side effects, and improves the functional capacity of patient in the treatment of spasticity.