COMPARISON OF 2 INJECTION TECHNIQUES USING BOTULINUM TOXIN IN SPASTICHEMIPLEGIA

This study sought to test the hypothesis that injections of botulinum toxin type A (BTX-A) at the mid belly of the gastrocnemius muscle in s pastic hemiplegic adults produce superior clinical results to proximal injections directed toward the muscular origin. We designed a randomi zed, double-blind, placebo-controlled intervention study at a universi ty tertiary care setting. Seventeen subjects with chronic spastic hemi plegic gait were enrolled from a volunteer community sample; time rang e from acute neurologic insult was 0.75 to 31 yr; age range was 19 to 71 yr; gender consisted of 11 men and 4 women; diagnoses were 12 patie nts with stroke, 2 with traumatic brain injuries, and 1 with a brain t umor, Two subjects were withdrawn from the study because of (1) acute vascular occlusion before intervention and (2) noncompliance with foll ow-up visits. After baseline measurements, subjects were injected with 50 units of BTX-A (volume, 0.5 cc) into the medial or lateral gastroc nemius: (1) proximally at one site near the muscular origin; (2) dista lly at three sites along the mid belly. We measured outcome using the Fugl-Meyer score, Ashworth scale, ankle range of motion, and a timed 5 0-ft fastest walk. No outcome measures showed a significant effect att ributable to site of injections. Confounding variables included physic al therapy and varying duration of illness in the study cohort. We con clude that the results failed to support the hypothesis that BTX-A inj ections at the mid belly of the gastrocnemius produced superior functi onal improvements to injections located near the muscular origin using localization techniques described. Additional research comparing more precise localization methods for BTX-A injections might Further estab lish the importance of electromyographic guidance using BTX-A in manag ement of spasticity.