Abstract
Objectives: To find the effect of botulinum toxin A on upper and lower limb spasticity and compare functional scale with a global scale of spasticity.
Methods: This is an open level prospective study, involving patients with upper and lower limb spasticity. Assessment were done at 3 weeks, 12 weeks, and at 24 weeks post injections. The Modified Ashworth and Modified Tardieu scale of spasticity, Percentage of passive range motion, Motricity Index was used. A total of 34 patients were enrolled 25 male, 9 female. There were 51 upper limb and 49 lower limb muscle groups. Three patients were lost during follows up.
Results: There was significant improvement in all the parametric variables after injections. Aggregate outcome scores comparing groups post base line showed significant difference in Modified Tardieu (MTS), Motricity Index (MI), Interventional goal assessment (IGA) scales muscle groups other than FIM. Lower limb faring better then upper limb spasticity.
Conclusion: Botulinum toxin A is an effective modality of treatment in appropriate clinical cases.
Keywords: Spasticity, Botulinum toxin A, upper limb, lower limb, Motricity Index, FIM.
References
- Koman LA, Mooney JF, Smith BP-Management of cerebral palsy with botulinum toxin A report of preliminary randomized, double blind trial. J Paeditr Orthop 1994; 14:299-303.
- Boyd RN, Graham HK-Botulinum toxin in the management of children with cerebral palsy: indication and outcome. Eur J Neurol 1997; 4(suppl 2):15-22.
- Yablon SA, Agana BT, IvanhoeCB, Boake C- Botulinum toxin in severe upper extremity spasticty among patient with traumatic brain injury: An open-labeled trial. Neurology 1996; 47:939-44.
- Autti-Ramo I , Larsen A , Taimo A, von Wendt L- Management of upper limb with botulinum toxin type A in children with spastic type cerebral palsy and acquired brain injury ;clinical implications. European Journal of Neurology 2001; 8(suppl5):S136-44.
- Brashear A ,Gordon M, Elovic E , Kassicieh VD, Marciniak C, Do M, Lee CH, Jenkins S, Turkel C- Botox Post Stroke Spasticity Study Group. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. New England Journal of Medicine 2002; 347:395-400.
- Dengler R , Neyer U , Wohlfarth K, Bettig U, Janzik HH- Local botulinum toxin in treatment of spastic foot drop. Journal of neurology 1992; 239; 375-8.
- Merholz J et .al- Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study .Clin Rehabil.2005 Oct: 751-9.
- Fosang AL,Galea MP,McCoy AT, Reddiough DS,Story I- Measures of muscle and joint performance in lower limb of children with cerebral palsy.Dev Med Child Neurol.2003 45:664-670.
- Kay RM, Rethlefsen SA, Fern-Buneo A, Wren TA, Skaggs DL-Botulinum toxin as an adjunct to serial casting treatment in children with cerebral palsy. J Bone Joint Surg Am.2004 86:2377-2384.
- Frank Reiter, Maura Danni et al-Disability Changes after Treatment of Upper Limb Spasticity with Botulinum Toxin. Neurorehabilitation and Neural Repair 1996:vol.10, No. 1, 47-52.
- Sheean, Geoffrey L.Botulinum treatment of spasticity- why is it so difficult to show a functional benefit? - Current Opinion in Neurology 2001: vol 14-Issue 6-pp 771-776.
- David C Good-Measurement of spasticity.In Clinical evaluation and management of spasticity - Current Clinical Neurology .Human Press 2002:40.
- Kirsten Graces,Anna McCormick et al-Botulinum Toxin A for Upper and Lower Limb Spasticity :A Systemic Review Canadian Coordinating Office for Health Technology Assesment :February 2005.
Corresponding Author
Dr Kshetra Madhab Das, MBBS, M.D. (PM&R)
Associate Professor, Department of Physical Medicine and Rehabilitation, NRS Medical College, Kolkata, West Bengal 700014, India
Address: Fl 4N, Bl A, Sherwood Estate, 169 NSC Bose Road, Kolkata 700103, India
Phone: 9830790414, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.