BOTULINUM TOXIN TREATMENT FOR LOWER-LIMB EXTENSOR SPASTICITY IN CHRONIC HEMIPARETIC PATIENTS

Twelve chronic hemiparetic outpatients with pronounced lower limb exte nsor spasticity were injected with 400 units of botulinum toxin A, EMG guided into the soleus, tibialis posterior, and both heads of the gas trocnemius muscles. Botulinum toxin A caused a definite reduction of p lantar flexor spasticity, in 10 patients two weeks after the injection , as assessed by the Ashworth scale. Four of the patients were able to achieve active dorsiflexion of their affected ankle. Gait analysis in cluding the measurement of vertical ground reaction forces showed a st atistically significant (p < 0.01) improvement in velocity, stride len gth, stance symmetry, and the length of the force point of action unde r the affected foot. Qualitative improvements on the force diagrams in dicated a better loading, advancement of the body, and push off of the affected limb in seven patients. Eight weeks after the injection the effects waned.