BOTULINUM TOXIN-A IN THE TREATMENT OF SPASTICITY - FUNCTIONAL IMPLICATIONS AND PATIENT SELECTION

Objective: To explore the range of functional indications and benefit of botulinum toxin A (BTA) in spastic patients. Design: Case report of a series of patients selected for BTA treatment. Clinical information was collected in a prospective fashion on each patient. Setting: Free standing acute rehabilitation hospital. Patients: 39 consecutive patie nts with 40 limbs with acquired spasticity. Intervention: All 39 patie nts received BTA injections into muscles targeted for treatment based on functional indications. Main Outcome Measures: Objective evaluation of outcome was measured by Ashworth Scale, goniometry, ambulation sco re, and brace wear scale. Subjective measures included patient self re port of improvement and pain relief. Results: Mean BTA dose per limb w as 180 units, mean number of muscles injected per limb was 2. Twenty-n ine patients had subjective and/or objective improvement with treatmen t. Mean Ashworth Scale improvement was one point. Mean gain in active range of motion (AROM) was 17.0 degrees, and in passive range of motio n (FROM) 18.4 degrees. Brace tolerance improved in 14 of 22 patients a nd pain relief occurred in 10 of 13 patients. There were no adverse ef fects, and there was no difference in duration of effect compared to d ystonia patients. Conclusion: BTA is a useful intervention in the trea tment of spasticity, with the majority of patients demonstrating impro vement on objective measures of tone and function, and reporting impro vement on subjective measures. Careful patient selection will maximize functional benefit. (C) 1996 by the American Congress of Rehabilitati on Medicine and the American Academy of Physical Medicine and Rehabili tation.