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Time course analysis of the effects of botulinum toxin type a on elbow spasticity based on biomechanic and electromyographic parameters.

Abstract：

OBJECTIVE:To quantify changes of elbow spasticity over time after botulinum toxin type A (BTX-A) injection in the upper extremity of stroke patients. DESIGN:Before-after trial in which the therapeutic effects were followed up at 2, 6, and 9 weeks after the BTX-A injection (Botox). SETTING:Hospital. PARTICIPANTS:Chronic stroke patients (N=8) with upper-limb spasticity. INTERVENTION:BTX-A was injected in upper-limb muscles, including the biceps brachii. MAIN OUTCOME MEASURES:Treatment effects were quantified as the changes in the velocity and the length dependence of hyperexcitable stretch reflexes. Manual sinusoid stretches of the elbow joint at 4 frequencies (1/3, 1/2, 1, 3/2Hz) over a movement range of 60 degrees were performed on patients by using a portable device. The Modified Ashworth Scale (MAS), biomechanic viscosity, and the reflexive electromyography threshold (RET) of the biceps brachii were used to evaluate the degree of hypertonia. RESULTS:The statistical analyses of the MAS score, biomechanic viscosity, and RET revealed a significant decrease in spasticity after the injection (all P<.05). Moreover, our quantitative parameters (biomechanic viscosity, RET) revealed small changes in spasticity after the BTX-A injection that could not be observed from clinical MAS evaluations. Five of 8 subjects showed a maximal reduction in spasticity (in terms of biomechanic viscosity value) within 6 weeks after the injection, whereas it was notable that all subjects exhibited peak RET values at either 2 or 6 weeks after the injection with variable degrees of relapse of spasticity. CONCLUSIONS:Early relapse of spasticity (within 9 weeks of the injection) can be detected from biomechanic and neurophysiologic assessments in a clinical setup. These quantitative indices provide valuable information for clinicians when making decisions to perform additional rehabilitation interventions or another BTX-A injection in the early stages of treatment.

journal_name

Arch Phys Med Rehabil

journal_title

Archives of physical medicine and rehabilitation

authors

Lee HM,Chen JJ,Wu YN,Wang YL,Huang SC,Piotrkiewicz M

doi

10.1016/j.apmr.2007.08.166

subject

Has Abstract

pub_date

2008-04-01 00:00:00

pages

692-9

issue

eissn

0003-9993

issn

1532-821X

pii

S0003-9993(08)00011-7

journal_volume

pub_type

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Time course analysis of the effects of botulinum toxin type a on elbow spasticity based on biomechanic and electromyographic parameters.