ANTISPASMODIC EFFECT OF BOTULINUM TOXIN TYPE A ON SPASTIC HEMIPLEGIA DUE TO CEREBROVASCULAR ACCIDENT

Background – The current methods of treating muscle spasticity are not fully desirable. The present study was conducted to assess the effect of botulinum toxin type A (BTA) on spastic hemiplegia due to cerebrovascular accident as a therapeutic modality. Methods – Thirty-eight patients with a history of stroke who signed an informed consent were treated with BTA within a year (mid-2001 to mid-2002) in Azzahra Hospital, Isfahan, Iran. Five-hundred units of botulinum toxin type A was injected into the flexor carpi ulnaris, flexor carpi radialis, flexor digitorum profundus, and biceps brachii muscles. The injections were repeated 2 – 4 times for some patients at three-month intervals. The level of spasticity was assessed before injection, based on Ashworth scale. Response to treatment was evaluated according to the Global Assessment table. The range of motion of the wrist and elbow joints as well as patientsʹ satisfaction with the treatment were evaluated before and after the intervention. Wilcoxon test was used to compare the data before and after the intervention. SPSS 9 software (SPSS Co, Chicago, IL, USA) was used to analyze the data. Results – Mild to moderate reduction in spasticity was observed in the hands of 13 (34.2%) and arms of 14 (35.55%) patients following injections. This reduction in spasticity was temporary, lasting for two to three months. Patients with severe reduction of range of motion prior to treatment experienced more satisfactory improvement than those with mild to moderate reduction in range of motion. Improvement in the range of motion of the wrist joint corresponded to that of the elbow. Sixty percent of the patients reported “moderate” to “good” improvement in their conditions. Conclusion – Injection of botulinum toxin type A can temporarily reduce limb spasticity after stroke and improve the range of motion of involved joints, bringing about patientsʹ satisfaction. However, the effect of botulinum toxin type A on the underlying etiology of disability is open to question.