USE OF BOTULINUM TOXIN IN STROKE PATIENTS WITH SEVERE UPPER-LIMB SPASTICITY

Objectives-Spasticity can contribute to poor recovery of upper limb fu nction after stroke. This is a preliminary evaluation of the impact of botulinum toxin treatment on disability caused by upper limb spastici ty after stroke. Methods-Seventeen patients with severe spasticity and a non-functioning arm were treated with intramuscular botulinum A neu rotoxin (median age at treatment 54.5 years; median time between onset of stroke and treatment 1.5 years). Baseline and assessments two week s after treatment were compared to assess efficacy. The duration of im provement in disability was documented. Outcome measures used were: pa ssive range of movement at the shoulder, elbow, wrist, and fingers; mo dified Ashworth scale to assess spasticity of biceps and forearm finge r flexors; an eight point scale to assess the degree of difficulty exp erienced by the patient or carer for each functional problem defined b efore treatment; the presence of upper limb pain. The biceps, forearm finger flexors, and flexor carpi ulnaris were treated with intramuscul ar botulinum toxin. Up to a total dose of 400-1000 mouse units (MU) of Dysport (Speywood) or 100-200 MU of BOTOX(R) (Allergan) was used in e ach patient. Results-Functional problems reported by the patients befo re treatment were difficulty with cleaning the palm, cutting fingernai ls, putting the arm through a sleeve, standing and walking balance, pu tting on gloves, and rolling over in bed. Hand hygiene improved in 14 of 17 patients; difficulty with sleeves improved in four of 16; standi ng and walking balance improved in one of four; shoulder pain improved in six of nine; wrist pain improved in five of six. Passive range of movement at shoulder, elbow, and wrist improved after treatment. Benef it was noted within two weeks and lasted one to 11 months. No adverse effects occurred. Conclusion-This preliminary study suggests that intr amuscular botulinum toxin is a safe and effective treatment for reduci ng disability in patients with severe upper limb spasticity.