Evaluation of efficacy and safety of Botulinum toxin–A in management of post stroke spasticity

Pushpendra N Renjen; Dr. Mirza Atif Beg; Dr. Dinesh Chaudhari; Mr Tarun Lala

Volume : VI, Issue : VIII, August - 2017

Evaluation of efficacy and safety of Botulinum toxin–A in management of post stroke spasticity

Pushpendra N Renjen, Dr. Mirza Atif Beg, Dr. Dinesh Chaudhari, Mr Tarun Lala

Abstract :

Background: Spasticity is a major disabling complication of stroke. The use of botulinum toxin–A is becoming a common treatment due to its efficacy and favorable side effects profile but uncertainty exists; that whether intramuscular injections of botulinum toxin–A reduce disability in persons with spasticity.

Objective: This study of conducted with the objective to assess the efficacy and safety of botulinum toxin–A in post stroke spasticity.

Methods: A total of 107 patients with moderate to severe spasticity (based on the Modified Ashworth Spasticity Scale) 3–6 months after stroke or those with poor response to the conventional, physical and medical treatment were included in the study. Each patient was assessed by the stroke neurologist, experimental neuro–physiotherapist and a medical observer on the basis of Modified Ashworth Spasticity Scale, Disability Four Point Scale, Visual Pain Assessment Scale (VAS), Range of Movements (ROM) & Assessment of Daily Living (ADL). The botulinum toxin–A (BTX–A) injected into spastic muscles with the guide of electromyography (EMG). Keeping in view the safety of the patients, the dose was not injected at < 3month interval.

Results: A total of 107 patients were included in the study. The underlying cause was ischemic stroke in 77 (71.96%), hemorrhagic stroke in 24 (22.43%), cereal embolism in 4 (3.74%) of the patients. The patients have shown improvement in the modified Ashworth scale score, range of movements and activities of daily living and improvement in disability with BTX–A at the end of the study. 30(62.5%) of upper limb spasticity and 41(69.5%) patients with lower limb spasticity, shown improvement in the range of movements. No serious adverse events were reported in the study period.

Conclusion: Our results showed that BTX–A treatment in post stroke spasticity safely and effectively decreases muscle tone and improves the range of motion, limb posture, function and pain.