1
|
Medawar N, Abdallah R, Kobaiter Maarrawi S, Maarrawi J. Intrathecal Baclofen Therapy for Refractory Spasticity: A Case Series. World Neurosurg 2024:S1878-8750(24)00762-9. [PMID: 38734171 DOI: 10.1016/j.wneu.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Management of refractory spasticity symptoms remains a challenging task for clinicians. Intrathecal baclofen (ITB) therapy has emerged as a promising option for treating this condition. This study evaluates the effectiveness of ITB therapy in managing refractory spasticity symptoms. METHODS A retrospective chart review was conducted on 34 patients with refractory spasticity symptoms who underwent ITB therapy at a single institution. The patients' demographics, clinical characteristics, and dosages were recorded. The primary outcome measures were the reduction in pain, improvement in mobility, decrease in spasm frequency, and alleviation of spasticity. RESULTS ITB therapy successfully reduced pain, improved mobility, decreased spasm frequency, and alleviated spasticity. The mean daily administered dose was 245 μg (range: 88-510 μg, standard deviation:104). However, it was observed that the appropriate dosage of ITB therapy was patient-specific and time-sensitive. Moreover, side effects were observed when an incorrect dose was administered. CONCLUSIONS ITB therapy is an effective and safe option for managing refractory spasticity symptoms. However, the appropriate dosage should be individualized and monitored closely to avoid side effects. This study highlights the importance of carefully considering the potential risks and benefits of ITB therapy for each patient.
Collapse
Affiliation(s)
- Nicolas Medawar
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon.
| | - Ralph Abdallah
- Faculty of arts and sciences, University of Toronto, Toronto, Canada
| | - Sandra Kobaiter Maarrawi
- Laboratory of Research in Neuroscience (LAREN), Pôle Technologie Santé (PTS), Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Joseph Maarrawi
- Laboratory of Research in Neuroscience (LAREN), Pôle Technologie Santé (PTS), Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon; Department of Neurosurgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| |
Collapse
|
2
|
Levy J, Karam P, Forestier A, Loze JY, Bensmail D. Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France. Front Neurol 2023; 14:1245228. [PMID: 37681005 PMCID: PMC10482253 DOI: 10.3389/fneur.2023.1245228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Background Current guidelines recommend intramuscular botulinum toxin type A (BoNT-A) injection as first-line treatment for spasticity, a frequent and impairing feature of various central nervous system (CNS) lesions such as stroke. Patients with spasticity commonly require BoNT-A injections once every 3 to 4 months. We conducted a nationwide, population-based, retrospective cohort study, using the French National Hospital Discharge Database (PMSI), to describe BoNT-A use for spasticity in clinical practice in France between 2014 and 2020. The PMSI database covers the whole French population, corresponding to over 66 million persons. Methods We first searched the PMSI database for healthcare facility discharge of patients who received BoNT-A injections between 2014 and 2020, corresponding to the first set. For each BoNT-A-treated patient, we identified the medical condition for which BoNT-A may have been indicated. Another search of the PMSI database focused on patients admitted for acute stroke between 2014 and 2016 and their spasticity-related care pathway (second set). Overall, two subpopulations were analysed: 138,481 patients who received BoNT-A injections between 2014 and 2020, and 318,025 patients who survived a stroke event between 2014 and 2016 and were followed up until 2020. Results Among the 138,481 BoNT-A-treated patients, 53.5% received only one or two BoNT-A injections. Most of these patients (N = 85,900; 62.0%) received BoNT-A because they had CNS lesions. The number of patients with CNS lesions who received ≥1 BoNT-A injection increased by a mean of 7.5% per year from 2014 to 2019, but decreased by 0.2% between 2019 and 2020, corresponding to the COVID-19 outbreak. In stroke survivors (N = 318,025), 10.7% were coded with post-stroke spasticity, 2.3% received ≥1 BoNT-A injection between 2014 and 2020, and only 0.8% received ≥3 injections within the 12 months following BoNT-A treatment initiation, i.e., once every 3 to 4 months. Conclusion Our analysis of the exhaustive PMSI database showed a suboptimal implementation of BoNT-A treatment recommendations in France. BoNT-A treatment initiation and re-administration are low, particularly in patients with post-stroke spasticity. Further investigations may help explain this observation, and may target specific actions to improve spasticity-related care pathway.
Collapse
Affiliation(s)
- Jonathan Levy
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital, AP-HP, Université Paris-Saclay, Garches, France
- Unité INSERM 1179, University of Versailles Saint-Quentin-en-Yvelines, Montigny-Le-Bretonneux, France
| | | | | | | | - Djamel Bensmail
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital, AP-HP, Université Paris-Saclay, Garches, France
- Unité INSERM 1179, University of Versailles Saint-Quentin-en-Yvelines, Montigny-Le-Bretonneux, France
| |
Collapse
|
3
|
Seol A, Chan J, Micham B, Ye Y, Mariano ER, Harrison TK, Hunter OO. Acute pain service reduces barriers to buprenorphine/naloxone initiation by using regional anesthesia techniques. Reg Anesth Pain Med 2023; 48:425-427. [PMID: 36792313 DOI: 10.1136/rapm-2022-104317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Medications for opioid use disorder (MOUD) are a life-saving intervention; thus, it is important to address barriers to successful initiation. Spasticity affects many patients with spinal cord injury and can be painful and physically debilitating. Chronic painful conditions can lead to the illicit use of non-prescribed opioids, but fear of pain is a barrier to the initiation of MOUD. In this case report, we describe the novel use of botulinum toxin A injections to treat abdominal spasticity and facilitate Acute Pain Service-led buprenorphine/naloxone initiation in a patient with opioid use disorder and severe abdominal spasticity due to spinal cord injury. CASE PRESENTATION A patient with C4 incomplete tetraplegia and opioid use disorder complicated by abdominal spasticity refractory to oral antispasmodics and self-treating with intravenous heroin was referred to the Acute Pain Service for inpatient buprenorphine/naloxone initiation. The patient began to fail initiation of buprenorphine/naloxone secondary to increased pain from abdominal spasms. The patient was offered ultrasound-guided abdominal muscle chemodenervation with botulinum toxin A, which resulted in the resolution of abdominal spasticity and facilitated successful buprenorphine/naloxone initiation. At 6 months post-initiation, the patient remained abstinent from non-prescribed opioids and compliant with buprenorphine/naloxone 8 mg/2 mg three times a day. CONCLUSIONS This case report demonstrates that inpatient buprenorphine/naloxone initiation by an Acute Pain Service can improve the success of treatment by addressing barriers to initiation. Acute Pain Service clinicians possess unique skills and knowledge, including ultrasound-guided interventions, that enable them to provide innovative and personalized approaches to care in the complex opioid use disorder population.
Collapse
Affiliation(s)
- Alice Seol
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - John Chan
- Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Stanford, California, USA
| | - Brittni Micham
- Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Stanford, California, USA
- Physical Medicine and Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Ying Ye
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Oluwatobi O Hunter
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| |
Collapse
|
4
|
Gumussu K, Erhan B. Management of spasticity in individuals with spinal cord injury in the era of COVID-19 pandemic societal restrictions. Spinal Cord Ser Cases 2023; 9:17. [PMID: 37085485 PMCID: PMC10121424 DOI: 10.1038/s41394-023-00573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Cross-sectional telephone interviews. OBJECTIVE The coronavirus disease (COVID-19) pandemic placed unprecedented pressure on healthcare systems worldwide. Here, we aimed to investigate the disruptions in management of spasticity and activities of daily living (ADL) in individuals with spinal cord injury (SCI) during the COVID-19 pandemic. SETTING Two university hospitals in Istanbul, Turkey. METHODS Twenty-four individuals with SCI exhibiting moderate and severe spasticity were enroled. All participants underwent ultrasound-guided botulinum toxin type A (BoNT-A) injections at two centres. A self-rated spasticity survey prepared by the authors was conducted. We questioned whether there was an increase in spasticity and the need for new BoNT-A injections during the societal restrictions of the COVID-19 pandemic. Spasticity severity in the previous week was rated using a numeric rating scale (NRS). ADL disrupted by spasticity were assessed by asking open-ended questions. RESULTS In total, 75% participants reported a moderate increase in spasticity, 12.5% reported a severe increase, and 12.5% reported no difference. The mean spasticity NRS score was 6 (standard deviation = 2). Further, 87.5% (21) participants reported the need for BoNT-A treatment because of symptom re-emergence. When spasticity-induced deterioration in ADL was assessed, individuals mostly reported difficulties in walking, sitting on a wheelchair, and sleep disturbance due to spasticity. CONCLUSIONS Most (87.5%) individuals with SCI reported a moderate or severe increase in spasticity during COVID-19 restrictions. Individuals with disabilities are an especially sensitive group and require specialised care during extraordinary circumstances, such as pandemics, hurricanes, or earthquakes. SPONSORSHIP None.
Collapse
Affiliation(s)
- Kevser Gumussu
- University of Health Sciences, Gaziosmanpasa Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey.
| | - Belgin Erhan
- Istanbul Medeniyet University, School of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| |
Collapse
|
5
|
Kurtys K, Gonera B, Zielinska N, Podgórski M, Karauda P, Olewnik Ł. Localization of the gracilis muscle motor points - key considerations for botulinum neurotoxin injection and electrical stimulation. Ann Anat 2023; 248:152072. [PMID: 36863619 DOI: 10.1016/j.aanat.2023.152072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Muscle motor points are considered the best sites for electrode positioning in electrical stimulation and, by some researchers, for botulinum neurotoxin injections. The aim of this study is to locate the motor points in the gracilis muscle to improve muscle function maintenance and treatment of spasticity. MATERIAL AND METHODS Ninety-three gracilis muscles (49 right, 44 left), fixed in 10% formalin solution, were subjected to the research. All nerve branches running towards the muscle were precisely traced to each motor point. Specific measurements were collected. RESULTS The gracilis muscle presents multiple motor points (median of 12), all of which were localized on the deep (lateral) side of the muscle belly. Generally, motor points of this muscle were spread between 15% and 40% of the reference line length. CONCLUSION Our findings may help clinicians identify appropriate locations for electrode placement during electrical stimulation of the gracilis muscle; they also deepen our understanding of the correlation between motor points and motor end plates and improve the application of botulinum neurotoxin injections.
Collapse
Affiliation(s)
- Konrad Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Michał Podgórski
- Department of Diagnostic Imaging and Interventional Radiology, Veteran's Memorial Hospital, Medical University of Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| |
Collapse
|
6
|
Liu H, Fan L, Li J, Dangol S, Talifu Z, Ma X, Gong H, Du L. Combined selective peripheral neurotomy in the treatment of spastic lower limbs of spinal cord injury patients. Acta Neurochir (Wien) 2022; 164:2263-2269. [PMID: 35665860 PMCID: PMC9166246 DOI: 10.1007/s00701-022-05265-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
Objective To explore the therapeutic effect of combined selective peripheral neurotomy (cSPN) on the spasm of the lower limbs after spinal cord injury. Methods A prospective intervention (before-after trial) with an observational design was conducted in 14 spinal cord injury patients with severe lower limbs spasticity by cSPN. Given the severe spasm of hip adductor, triceps surae, and hamstring muscles in these patients, a total of 26 obturator nerve branches, 26 tibia nerve branches, and 4 sciatic nerve branches partial neurotomy were performed. The modified Ashworth scale, composite spasticity scale, surface electromyography, gait analysis, functional ambulation category, spinal cord independence measure, and modified spinal cord injury–spasticity evaluation tool were used before and after surgery. Results Compared with preoperative, the spasm of the hip adductor, triceps surae, and hamstrings of the lower limbs in the postoperative patients decreased significantly. The abnormal gait of knee flexion and varus in the standing stage were significantly reduced. The grading of walking ability and activities of daily living were significantly improved. Conclusions Combined selective peripheral neurotomy can significantly reduce the spasm of lower limbs post spinal cord injury, improve abnormal gait, and improve motor function and activities of daily living. Trial registration ChiCTR1800019003 (2018–10-20).
Collapse
Affiliation(s)
- Hongwei Liu
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Lianghua Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jun Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Subarna Dangol
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Zuliyaer Talifu
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Xiaodong Ma
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Han Gong
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Liangjie Du
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.
| |
Collapse
|
7
|
Biktimirov A, Pak O, Bryukhovetskiy I, Sharma A, Sharma HS. Neuromodulation as a basic platform for neuroprotection and repair after spinal cord injury. PROGRESS IN BRAIN RESEARCH 2021; 266:269-300. [PMID: 34689861 DOI: 10.1016/bs.pbr.2021.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Spinal cord injury (SCI) is one of the most challenging medical issues. Spasticity is a major complication of SCI. A combination of spinal cord stimulation, new methods of neuroprotection and biomedical cellular products provides fundamentally new options for SCI treatment and rehabilitation. The paper attempts to critically analyze the effectiveness of using these procedures for patients with SCI, suggesting a protocol for a step-by-step personalized treatment of SCI, based on continuity of modern conservative and surgical methods. The study argues the possibility of using neuromodulation as a basis for rehabilitating patients with SCI.
Collapse
Affiliation(s)
- Artur Biktimirov
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia.
| | - Oleg Pak
- Department of Neurosurgery, Medical Center, Far Eastern Federal University, Vladivostok, Russia
| | - Igor Bryukhovetskiy
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
8
|
Shorter AL, Richardson JK, Finucane SB, Joshi V, Gordon K, Rouse EJ. Characterization and clinical implications of ankle impedance during walking in chronic stroke. Sci Rep 2021; 11:16726. [PMID: 34408174 PMCID: PMC8373915 DOI: 10.1038/s41598-021-95737-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 07/29/2021] [Indexed: 12/02/2022] Open
Abstract
Individuals post-stroke experience persisting gait deficits due to altered joint mechanics, known clinically as spasticity, hypertonia, and paresis. In engineering, these concepts are described as stiffness and damping, or collectively as joint mechanical impedance, when considered with limb inertia. Typical clinical assessments of these properties are obtained while the patient is at rest using qualitative measures, and the link between the assessments and functional outcomes and mobility is unclear. In this study we quantify ankle mechanical impedance dynamically during walking in individuals post-stroke and in age-speed matched control subjects, and examine the relationships between mechanical impedance and clinical measures of mobility and impairment. Perturbations were applied to the ankle joint during the stance phase of walking, and least-squares system identification techniques were used to estimate mechanical impedance. Stiffness of the paretic ankle was decreased during mid-stance when compared to the non-paretic side; a change independent of muscle activity. Inter-limb differences in ankle joint damping, but not joint stiffness or passive clinical assessments, strongly predicted walking speed and distance. This work provides the first insights into how stroke alters joint mechanical impedance during walking, as well as how these changes relate to existing outcome measures. Our results inform clinical care, suggesting a focus on correcting stance phase mechanics could potentially improve mobility of chronic stroke survivors.
Collapse
Affiliation(s)
- Amanda L Shorter
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
- The Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - James K Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Suzanne B Finucane
- The Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Varun Joshi
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Keith Gordon
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Edward Hines Jr. Veterans Affairs Hospital, Hines, USA
| | - Elliott J Rouse
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.
- Core Faculty, Robotics Institute, The University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
9
|
Do gait parameters improve after botulinum toxin injections in post stroke patients? A prospective study. Toxicon 2021; 200:189-197. [PMID: 34384786 DOI: 10.1016/j.toxicon.2021.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/16/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022]
Abstract
The intramuscular injection of botulinum toxin is one of the most efficient ways to treat localized spasticity in patients suffering from Central Nervous System lesions like stroke, cerebral palsy and multiple sclerosis. The gait analysis based on kinetics and kinematics is a recognized way of measurement of the effect of intramuscular injection of botulinum toxin in spastic patients suffering from chronic stroke. The aim of this study is to provide evidence of the beneficial effect of botulinum toxin on characteristics of gait pattern on patients suffering from chronic stroke. So, thirteen patients with spasticity due to chronic stroke were included in the protocol and were treated by botulinum toxin injections in the lower extremity. All patients were evaluated before the injection as well as one month after the botulinum injection on a foot pressure sensitive walkway with a power plate and by the readings of seven inertial measurements units which recorded spatio-temporal specific parameters during walking, and the spasticity was measured according to modified Ashworth Scale. While all spatio-temporal parameters of motion analysis and balance improved for most of the patients after botulinum toxin injection, only one parameter, the normal to hemiplegic step length, reached statistical significant improvement (p < 0.03). Moreover the modified Ashworth score was statistically improved post injection (p < 0.001). In conclusion the use of botulinum toxin injections is beneficial in post stroke patients as this is depicted in gait parameters improvement which accompanies the spasticity reduction.
Collapse
|
10
|
Beretta-Piccoli M, Cescon C, Barbero M, D’Antona G. Identification of muscle innervation zones using linear electrode arrays: a fundamental step to measure fibers conduction velocity. ARAB JOURNAL OF BASIC AND APPLIED SCIENCES 2021. [DOI: 10.1080/25765299.2021.1894731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Matteo Beretta-Piccoli
- Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, SUPSI, Manno, Switzerland
- Criams-Sport Medicine Centre Voghera, University of Pavia, Pavia, Italy
| | - Corrado Cescon
- Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, SUPSI, Manno, Switzerland
| | - Marco Barbero
- Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, SUPSI, Manno, Switzerland
| | - Giuseppe D’Antona
- Criams-Sport Medicine Centre Voghera, University of Pavia, Pavia, Italy
- Department of Public Health, Experimental and Forensic medicine, University of Pavia, Pavia, Italy
| |
Collapse
|
11
|
Palazón-García R, Benavente-Valdepeñas AM. Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury. Int J Mol Sci 2021; 22:ijms22094886. [PMID: 34063051 PMCID: PMC8125452 DOI: 10.3390/ijms22094886] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
Botulism has been known for about three centuries, and since its discovery, botulinum toxin has been considered one of the most powerful toxins. However, throughout the 20th century, several medical applications have been discovered, among which the treatment of spasticity stands out. Botulinum toxin is the only pharmacological treatment recommended for spasticity of strokes and cerebral palsy. Although its use as an adjuvant treatment against spasticity in spinal cord injuries is not even approved, botulinum toxin is being used against such injuries. This article describes the advances that have been made throughout history leading to the therapeutic use of botulinum toxin and, in particular, its application to the treatment of spasticity in spinal cord injury.
Collapse
Affiliation(s)
- Ramiro Palazón-García
- Physical Medicine and Rehabilitation Department, Hospital Nacional de Parapléjicos, 45004 Toledo, Spain
- Correspondence:
| | | |
Collapse
|
12
|
Picelli A, Filippetti M, Sandrini G, Tassorelli C, De Icco R, Smania N, Tamburin S. Electrical Stimulation of Injected Muscles to Boost Botulinum Toxin Effect on Spasticity: Rationale, Systematic Review and State of the Art. Toxins (Basel) 2021; 13:toxins13050303. [PMID: 33922855 PMCID: PMC8146442 DOI: 10.3390/toxins13050303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 01/11/2023] Open
Abstract
Botulinum toxin type A (BoNT-A) represents a first-line treatment for spasticity, a common disabling consequence of many neurological diseases. Electrical stimulation of motor nerve endings has been reported to boost the effect of BoNT-A. To date, a wide range of stimulation protocols has been proposed in the literature. We conducted a systematic review of current literature on the protocols of electrical stimulation to boost the effect of BoNT-A injection in patients with spasticity. A systematic search using the MeSH terms “electric stimulation”, “muscle spasticity” and “botulinum toxins” and strings “electric stimulation [mh] OR electrical stimulation AND muscle spasticity [mh] OR spasticity AND botulinum toxins [mh] OR botulinum toxin type A” was conducted on PubMed, Scopus, PEDro and Cochrane library electronic databases. Full-text articles written in English and published from database inception to March 2021 were included. Data on patient characteristics, electrical stimulation protocols and outcome measures were collected. This systematic review provides a complete overview of current literature on the role of electrical stimulation to boost the effect of BoNT-A injection for spasticity, together with a critical discussion on its rationale based on the neurobiology of BoNT-A uptake.
Collapse
Affiliation(s)
- Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (A.P.); (M.F.); (N.S.)
| | - Mirko Filippetti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (A.P.); (M.F.); (N.S.)
| | - Giorgio Sandrini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (G.S.); (C.T.); (R.D.I.)
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (G.S.); (C.T.); (R.D.I.)
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (G.S.); (C.T.); (R.D.I.)
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (A.P.); (M.F.); (N.S.)
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (A.P.); (M.F.); (N.S.)
- Correspondence:
| |
Collapse
|
13
|
Baral H, Sekiguchi A, Uchiyama A, Nisaa Amalia S, Yamazaki S, Inoue Y, Yokoyama Y, Ogino S, Torii R, Hosoi M, Akai R, Iwawaki T, Ishikawa O, Motegi SI. Inhibition of skin fibrosis in systemic sclerosis by botulinum toxin B via the suppression of oxidative stress. J Dermatol 2021; 48:1052-1061. [PMID: 33840125 DOI: 10.1111/1346-8138.15888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022]
Abstract
Oxidative stress has been reported to play an important role in the pathogenesis of skin fibrosis in systemic sclerosis (SSc). We previously identified that botulinum toxin (BTX) injection suppresses pressure ulcer formation in a cutaneous ischemia-reperfusion injury mouse model by regulation of oxidative stress. However, the therapeutic possibility of BTX administration for preventing skin fibrosis in SSc is unclear. The objective of this study was to investigate the effect of BTX-B on skin fibrosis in a murine model of SSc and determine the underlying mechanism. We found that BTX-B injection significantly reduced dermal thickness and inflammatory cell infiltration in bleomycin-induced skin fibrosis lesion in mice. We also identified that the oxidative stress signal detected through bioluminescence in OKD48 mice after bleomycin injection in the skin was significantly decreased by BTX-B. Additionally, mRNA levels of oxidative stress associated factors (NOX2, HO-1, Trx2) were significantly decreased by BTX-B. Apoptotic cells in the lesional skin of bleomycin-treated mice were significantly reduced by BTX-B. Oxidant-induced intracellular accumulation of reactive oxygen species in SSc fibroblasts was also inhibited by BTX-B. In conclusion, BTX-B might improve bleomycin-induced skin fibrosis via the suppression of oxidative stress and inflammatory cells in the skin. BTX-B injection may have a therapeutic effect on skin fibrosis in SSc.
Collapse
Affiliation(s)
- Hritu Baral
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akiko Sekiguchi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihiko Uchiyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Syahla Nisaa Amalia
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sahori Yamazaki
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuta Inoue
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoko Yokoyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sachiko Ogino
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ryoko Torii
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Mari Hosoi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ryoko Akai
- Division of Cell Medicine, Department of Life Science, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Takao Iwawaki
- Division of Cell Medicine, Department of Life Science, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|
14
|
Diniz de Lima F, Faber I, Servelhere KR, Bittar MFR, Martinez ARM, Piovesana LG, Martins MP, Martins CR, Benaglia T, de Sá Carvalho B, Nucci A, França MC. Randomized Trial of Botulinum Toxin Type A in Hereditary Spastic Paraplegia - The SPASTOX Trial. Mov Disord 2021; 36:1654-1663. [PMID: 33595142 DOI: 10.1002/mds.28523] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hereditary spastic paraplegia presents spasticity as the main clinical manifestation, reducing gait quality and producing incapacity. Management with botulinum toxin type A (BoNT-A) is not well elucidated. The objective of the current study was to evaluate the efficacy and safety of BoNT-A in patients with hereditary spastic paraplegias. METHODS This was a double-blind, randomized, placebo-controlled crossover trial. Each participant was randomly assigned to receive 1 injection session of either BoNT-A (100 IU/2 mL of Prosigne in each adductor magnus and each triceps surae) or saline 0.9% (2 mL). The primary outcome measure was change from baseline in maximal gait velocity, and secondary outcome measures included changes in gait at self-selected velocity, spasticity, muscle strength, Spastic Paraplegia Rating Scale, pain, fatigue, and subjective perception of improvement. We also looked at adverse events reported by the patients. RESULTS We enrolled 55 patients, 36 of whom were men and 41 with the pure phenotype. Mean age was 43 ± 13.4 years (range, 19-72 years), mean age of onset waws 27 ± 13.1 years (range, <1 to 55 yars), and mean disease duration was 17 ± 12.7 years (range, 1-62 years). Compared with baseline, we did not find significant differences between groups in primary and secondary outcomes, except for reduction in adductor tone (P = 0.01). The adverse events were transient and tolerable, and their incidence did not significantly differ between treatments (P = 0.17). CONCLUSIONS BoNT-A was safe in patients with hereditary spastic paraplegias and reduced the adductor tone, but it was not able to produce functional improvement considering the doses, injection protocol, measures, and instruments used. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
| | - Ingrid Faber
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | | | - Luiza G Piovesana
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Melina P Martins
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Tatiana Benaglia
- Department of Statistics, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Anamarli Nucci
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marcondes C França
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| |
Collapse
|
15
|
Seth N, Johnson D, Allen B, Abdullah HA. Upper limb robotic assessment: Pilot study comparing velocity dependent resistance in individuals with acquired brain injury to healthy controls. J Rehabil Assist Technol Eng 2020; 7:2055668320929535. [PMID: 33329901 PMCID: PMC7720336 DOI: 10.1177/2055668320929535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/04/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Assessment of velocity dependent resistance (VDR) can provide insights into spasticity in individuals with upper motor neuron syndrome. This study investigates the relationship between Modified Ashworth scores and a biomechanical based representation of VDR using a rehabilitation robot. Comparisons in VDR are made for the upper limb (UL) between individuals with acquired brain injury and healthy controls for the para-sagittal plane. Methods The system manipulates the individual’s limb through five flexion and extension motions at increasing speeds to obtain force profiles at different velocities. An approximation of VDR is calculated and analyzed statistically against clinical scales and tested for interactions. Results All individuals (aged 18–65), including healthy controls exhibited VDR greater than 0 (P < 0.05). MAS scores were found to be related to VDR (P < 0.05) with an interaction found between MAS Bicep and Tricep scores (P < 0.01). Considering this interaction, evidence of differences in VDR were found between several neighboring assessment score combinations. Conclusion The robot can detect and quantify VDR that captures information relevant to UL spasticity. Results suggests a better categorization of VDR is possible and supports further development of rehabilitation robotics for assisting spasticity assessment.
Collapse
Affiliation(s)
- Nitin Seth
- College of Physical and Engineering Science, University of Guelph, Guelph, Canada
| | | | - Brian Allen
- College of Physical and Engineering Science, University of Guelph, Guelph, Canada
| | - Hussein A Abdullah
- College of Physical and Engineering Science, University of Guelph, Guelph, Canada
| |
Collapse
|
16
|
Amalia SN, Uchiyama A, Baral H, Inoue Y, Yamazaki S, Fujiwara C, Sekiguchi A, Yokoyama Y, Ogino S, Torii R, Hosoi M, Ishikawa O, Motegi SI. Suppression of neuropeptide by botulinum toxin improves imiquimod-induced psoriasis-like dermatitis via the regulation of neuroimmune system. J Dermatol Sci 2020; 101:58-68. [PMID: 33176965 DOI: 10.1016/j.jdermsci.2020.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/18/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psoriasis is a multifactorial disease arises from a complex interaction of genetics, immune system, and environmental aspects. IL-23/Th17 immune axis has been considered as a primary modulator in psoriasis. In addition, several findings imply that nervous system may take a part in the pathogenesis of psoriasis, suggesting that nervous system, through its neuropeptide, may interact with immune system and lead to the formation of psoriasis. OBJECTIVE We aimed to ascertain the role of neuropeptides secreted from neurons in the pathogenesis of psoriasis in vivo. METHODS The release of neuropeptide was inhibited by injecting Botulinum toxin B (BTX-B) on Imiquimod (IMQ)-induced psoriasis-like dermatitis mice model. Quantification of skin dermatitis, infiltrating inflammatory cells, and the production of cytokines at the lesional skin area were performed by PSI score, immunostaining, and real-time PCR. We also tested the effect of selective CGRP antagonist (CGRP8-37) on psoriasis-like dermatitis in IMQ-treated mice. RESULTS BTX-B injection significantly suppressed PSI score and reduced the number of CD4+ T cells, CD11c+ dendritic cells, and the production of IL-17A/F in the lesional skin. The expressions of PGP9.5+ nerve fibers and neuropeptides (SP, CGRP) were also significantly reduced following BTX-B injection. Additionally, CGRP antagonist also suppressed the development of IMQ-induced psoriasis-like dermatitis in mice. CONCLUSION The suppression of neuropeptide secretion in the skin by BTX injection might inhibit nerve elongation, the infiltration of immune cells, as well as IL-17 production, resulting in the improvement of psoriasis. Neuropeptide inhibitor could also be applied to the treatment of psoriasis.
Collapse
Affiliation(s)
- Syahla Nisaa Amalia
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihiko Uchiyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hritu Baral
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuta Inoue
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sahori Yamazaki
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Chisako Fujiwara
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akiko Sekiguchi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoko Yokoyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sachiko Ogino
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ryoko Torii
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Mari Hosoi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
| |
Collapse
|
17
|
Esquenazi A, Bavikatte G, Bandari DS, Jost WH, Munin MC, Tang SFT, Largent J, Adams AM, Zuzek A, Francisco GE. Long-Term Observational Results from the ASPIRE Study: OnabotulinumtoxinA Treatment for Adult Lower Limb Spasticity. PM R 2020; 13:1079-1093. [PMID: 33151636 PMCID: PMC8519010 DOI: 10.1002/pmrj.12517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 09/24/2020] [Accepted: 10/23/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION OnabotulinumtoxinA treatment for spasticity varies according to numerous factors and is individualized to meet treatment goals. OBJECTIVE To explore real-world onabotulinumtoxinA utilization and effectiveness in patients with lower limb spasticity from the Adult Spasticity International Registry (ASPIRE) study. DESIGN Two-year, multicenter, prospective, observational registry (NCT01930786). SETTING Fifty-four international clinical sites. PATIENTS Adults (naïve or non-naïve to botulinum toxin[s] treatment for spasticity, across multiple etiologies) with lower limb spasticity related to upper motor neuron syndrome. INTERVENTIONS OnabotulinumtoxinA administered at the clinician's discretion. MAIN OUTCOME MEASURES OnabotulinumtoxinA treatment utilization, clinician- and patient-reported satisfaction. RESULTS In ASPIRE, 530 patients received ≥1 onabotulinumtoxinA treatment for lower limb spasticity (mean age, 52 years; stroke, 49.4%; multiple sclerosis, 20.4%). Equinovarus foot was treated most often (80.9% of patients), followed by flexed knee (26.0%), stiff extended knee (22.5%), and flexed toes (22.3%). OnabotulinumtoxinA doses ranged between 10 and 1100 U across all presentations. Electromyography (EMG) was most commonly used for injection localization (≥41.1% of treatment sessions). Despite low patient response on the satisfaction questionnaire, clinicians (94.6% of treatment sessions) and patients (84.5%) reported satisfaction/extreme satisfaction that treatment helped manage spasticity, and clinicians (98.3%) and patients (91.6%) would probably/definitely continue onabotulinumtoxinA treatment. These data should be interpreted with care. Twenty-one adverse events (AEs) in 18 patients (3.4%) were considered treatment-related. Sixty-seven patients (12.6%) reported 138 serious AEs; 3 serious AEs in two patients (0.4%) were considered treatment-related. No new safety signals were identified. CONCLUSIONS ASPIRE provides long-term observational data on the treatment of lower limb spasticity with onabotulinumtoxinA. Real-world data from this primary analysis can help to guide the clinical use of onabotulinumtoxinA to improve spasticity management.
Collapse
Affiliation(s)
| | | | | | - Wolfgang H Jost
- Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany.,Parkinson-Klinik Ortenau, Wolfach, Germany
| | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Simon Fuk Tan Tang
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Joan Largent
- IQVIA Real-World Evidence Solutions, Cambridge, MA, USA
| | | | | | - Gerard E Francisco
- University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, TX, USA
| |
Collapse
|
18
|
Francisco GE, Bandari DS, Bavikatte G, Jost WH, McCusker E, Largent J, Zuzek A, Esquenazi A. High clinician- and patient-reported satisfaction with individualized onabotulinumtoxinA treatment for spasticity across several etiologies from the ASPIRE study. Toxicon X 2020; 7:100040. [PMID: 32875289 PMCID: PMC7452133 DOI: 10.1016/j.toxcx.2020.100040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 04/23/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022] Open
Abstract
Etiology-specific onabotulinumtoxinA utilization to manage spasticity is largely unknown. In this 1-year interim analysis, we evaluated real-world onabotulinumtoxinA utilization and effectiveness across several etiologies from the Adult Spasticity International Registry (ASPIRE) study. ASPIRE is a multicenter, prospective, observational registry (NCT01930786) examining stroke, multiple sclerosis [MS], cerebral palsy [CP], traumatic brain injury [TBI], and spinal cord injury [SCI] patients with spasticity treated with onabotulinumtoxinA at the clinician's discretion. Assessments included onabotulinumtoxinA utilization (each session), clinician (subsequent session)/patient (5±1 weeks post-treatment) satisfaction, and the Disability Assessment Scale (DAS; subsequent session). 730 patients received ≥1 onabotulinumtoxinA treatment, with 37% naïve to botulinum toxin(s) for spasticity. The most common etiology was stroke (n=411, 56%), followed by MS (N=119, 16%), CP (N=77, 11%), TBI (N=45, 6%), and SCI (N=42, 6%). The total body mean cumulative dose (±SD) of onabotulinumtoxinA per session ranged from 296 U (±145) in CP to 406 U (±152) in TBI. The most commonly treated upper limb presentations were clenched fist (stroke, MS, and SCI), flexed wrist (CP), and flexed elbow (TBI). Equinovarus foot was the most commonly treated lower limb presentation in all etiologies. Stroke patients showed improved DAS scores for nearly all subscales in both limbs, indicative of improved global function. All etiologies showed improved lower limb mobility DAS scores. Across all sessions, clinicians (range: 87.4% [SCI]-94.2% [CP]) and patients (range: 67.6% [TBI]-89.7% [SCI]) reported extreme satisfaction/satisfaction that onabotulinumtoxinA helped manage spasticity, and clinicians (range: 94.6% [TBI]-98.8% [CP]) and patients (range: 88.4% [stroke]-91.2% [TBI]) would definitely/probably continue treatment. Treatment-related adverse events (TRAEs) and treatment-related serious adverse events (TRSAEs) were reported as follows: stroke: 10 TRAEs (2.2% patients), 3 TRSAEs (0.5%); MS: 5 TRAEs (4.2%), 0 TRSAEs; CP: 0 TRAEs, 0 TRSAEs; TBI: 1 TRAEs (2.2%), 0 TRSAEs; SCI: 0 TRAEs, 0 TRSAEs. No new safety signals were identified. High clinician- and patient-reported satisfaction were observed following individualized onabotulinumtoxinA treatment, as well as improved global function. Interim results from ASPIRE demonstrate etiology-specific similarities and differences in clinical approaches to manage spasticity. ASPIRE found etiology-specific similarities and differences in real-world onabotulinumtoxinA utilization for spasticity. Across all etiologies, there was high clinician- and patient-reported satisfaction with onabotulinumtoxinA treatment. In DAS, all etiologies showed improved global function in lower limb mobility following onabotulinumtoxinA treatment. Adverse event data varied by etiology of spasticity; however, no new safety signals were identified. ASPIRE data may guide clinical strategies and educational programs to improve onabotulinumtoxinA spasticity management.
Collapse
Affiliation(s)
- Gerard E Francisco
- The University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, TX, USA
| | - Daniel S Bandari
- Multiple Sclerosis Center of California & Research Group, Newport Beach, CA, USA
| | | | - Wolfgang H Jost
- University of Freiburg, Department of Neurology, Freiburg im Breisgau, Germany.,Parkinson-Klinik Ortenau, Wolfach, Germany
| | | | - Joan Largent
- IQVIA Real-World Evidence Solutions, Cambridge, MA, USA
| | | | | |
Collapse
|
19
|
Luvisetto S. Botulinum Toxin and Neuronal Regeneration after Traumatic Injury of Central and Peripheral Nervous System. Toxins (Basel) 2020; 12:toxins12070434. [PMID: 32630737 PMCID: PMC7404966 DOI: 10.3390/toxins12070434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) are toxins produced by the bacteria Clostridiumbotulinum, the causing agent for botulism, in different serotypes, seven of which (A–G) are well characterized, while others, such as H or FA, are still debated. BoNTs exert their action by blocking SNARE (soluble N-ethylmale-imide-sensitive factor-attachment protein receptors) complex formation and vesicle release from the neuronal terminal through the specific cleavage of SNARE proteins. The action of BoNTs at the neuromuscular junction has been extensively investigated and knowledge gained in this field has set the foundation for the use of these toxins in a variety of human pathologies characterized by excessive muscle contractions. In parallel, BoNTs became a cosmetic drug due to its power to ward off facial wrinkles following the activity of the mimic muscles. Successively, BoNTs became therapeutic agents that have proven to be successful in the treatment of different neurological disorders, with new indications emerging or being approved each year. In particular, BoNT/A became the treatment of excellence not only for muscle hyperactivity conditions, such as dystonia and spasticity, but also to reduce pain in a series of painful states, such as neuropathic pain, lumbar and myofascial pain, and to treat various dysfunctions of the urinary bladder. This review summarizes recent experimental findings on the potential efficacy of BoNTs in favoring nerve regeneration after traumatic injury in the peripheral nervous system, such as the injury of peripheral nerves, like sciatic nerve, and in the central nervous system, such as spinal cord injury.
Collapse
Affiliation(s)
- Siro Luvisetto
- Institute of Biochemistry and Cell Biology, National Research Council of Italy, via Ramarini 32, Monterotondo Scalo, 00015 Rome, Italy
| |
Collapse
|
20
|
Francisco GE, Jost WH, Bavikatte G, Bandari DS, Tang SFT, Munin MC, Largent J, Adams AM, Zuzek A, Esquenazi A. Individualized OnabotulinumtoxinA Treatment for Upper Limb Spasticity Resulted in High Clinician- and Patient-Reported Satisfaction: Long-Term Observational Results from the ASPIRE Study. PM R 2020; 12:1120-1133. [PMID: 31953896 PMCID: PMC7687094 DOI: 10.1002/pmrj.12328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/23/2019] [Indexed: 11/17/2022]
Abstract
Introduction OnabotulinumtoxinA treatment for spasticity is dependent on numerous factors and varies according to selected treatment goals. Objective To examine real‐world onabotulinumtoxinA treatment utilization and effectiveness in patients with upper limb spasticity over 2 years from the Adult Spasticity International Registry (ASPIRE) study. Design Multicenter, prospective, observational registry (NCT01930786). Setting Fifty‐four international clinical sites in North America, Europe, and Asia. Patients Adults (naïve or non‐naïve to botulinum toxins for spasticity) with upper limb focal spasticity related to upper motor neuron syndrome across multiple etiologies. Interventions OnabotulinumtoxinA administered at clinician's discretion. Main Outcome Measures OnabotulinumtoxinA utilization, clinician and patient satisfaction. Results Four hundred eighty‐four patients received ≥1 treatment of onabotulinumtoxinA for upper limb spasticity. Patients were on average 55.1 years old, 50.8% male, predominantly Caucasian (72.3%), and 38.6% were naïve to botulinum toxins. Stroke was the most frequently reported underlying etiology (74.0%). Most patients (81.2%) had moderate to severe spasticity at baseline. The most commonly treated upper limb clinical presentation was clenched fist (79.1% of patients). Across all presentations, onabotulinumtoxinA doses ranged between 5‐600U. Electromyography (EMG) was most often utilized to localize muscles (≥57.0% of treatment sessions). Clinicians (92.9% of treatment sessions) and patients (85.7%) reported being extremely satisfied/satisfied that treatment helped manage spasticity, and clinicians (98.6%) and patients (92.2%) would definitely/probably continue onabotulinumtoxinA treatment. One hundred seventy‐nine patients (37.0%) reported 563 adverse events (AEs); 15 AEs in 14 patients (2.9%) were considered treatment related. Sixty‐nine patients (14.3%) reported 137 serious AEs; 3 serious AEs in 2 patients (0.4%) were considered treatment related. No new safety signals were identified. Conclusions ASPIRE captured the real‐world individualized nature of onabotulinumtoxinA utilization for upper limb spasticity over 2 years, with consistently high clinician‐ and patient‐reported satisfaction. Data in this primary analysis will guide clinical use of onabotulinumtoxinA, as well as provide insights to improve educational programs on spasticity management.
Collapse
Affiliation(s)
- Gerard E Francisco
- The University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, TX
| | - Wolfgang H Jost
- Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Daniel S Bandari
- Multiple Sclerosis Center of California & Research Group, Newport Beach, CA
| | - Simon F T Tang
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Joan Largent
- IQVIA Real-World Evidence Solutions, Cambridge, MA
| | | | | | | |
Collapse
|
21
|
Paparella G, Vavla M, Bernardi L, Girardi G, Stefan C, Martinuzzi A. Efficacy of a Combined Treatment of Botulinum Toxin and Intensive Physiotherapy in Hereditary Spastic Paraplegia. Front Neurosci 2020; 14:111. [PMID: 32153352 PMCID: PMC7046620 DOI: 10.3389/fnins.2020.00111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/28/2020] [Indexed: 01/27/2023] Open
Abstract
Introduction The Hereditary Spastic Paraplegia (HSP) is a heterogeneous group of neurodegenerative disorders characterized by progressive spasticity and lower limbs (LL) weakness. There is no treatment to cure or halt the disease, except for symptomatic therapy. The use of botulinum toxin type A (BoNT-A) is one of the primary treatment for focal spasticity. Physiotherapy (PT) can help in maintaining residual functioning. We performed a retrospective study to evaluate the effect of the combined BoNT-A and intensive PT in patients with HSP. Methods Eighteen adult patients (50% females) with clinical diagnosis of HSP were recruited. Eleven patients had a genetic diagnosis of SPG4, 5, 7, 8, 11, 72. Patients were all autonomously deambulant or needed support. BoNT-A was injected in 36 LL in different spastic muscles under electromyographic guidance and followed by intensive PT sessions. Outcome measures included disease severity, motor functional measures, perceived pain self-report and quality of life. Assessments occurred at baseline, 1 and 3 months after BoNT-A injection. Results Most inoculated muscles were hamstrings, rectus femoris and gastrocnemius. We observed an improvement in muscle tone, in the gait velocity and distance length. Spastic Paraplegia Rating Scale was significantly reduced after treatment, in addition to improving pain and quality of life. These results were riconfirmed in 3 months time. Conclusion Our study indicates that combined treatment of BoNT-A and PT can lead to improvement of spasticity and quality of life in patients with HSP.
Collapse
Affiliation(s)
- Gabriella Paparella
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy
| | - Marinela Vavla
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy.,Severe Developmental Disabilities Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Italy
| | - Lisa Bernardi
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy
| | - Giulia Girardi
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy
| | - Cristina Stefan
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy
| | - Andrea Martinuzzi
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy.,Severe Developmental Disabilities Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Italy
| |
Collapse
|
22
|
Koo HJ, Park HJ, Park GY, Han Y, Sohn D, Im S. Safe Needle Insertion Locations for Motor Point Injection of the Triceps Brachii Muscle: A Pilot Cadaveric and Ultrasonography Study. Ann Rehabil Med 2019; 43:635-641. [PMID: 31918526 PMCID: PMC6960085 DOI: 10.5535/arm.2019.43.6.635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/30/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To determine the location of the motor endplate zones (MoEPs) for the three heads of the triceps brachii muscles during cadaveric dissection and estimate the safe injection zone using ultrasonography. Methods We studied 12 upper limbs of 6 fresh cadavers obtained from body donations to the medical school anatomy institution in Seoul, Korea. The locations of MoEPs were expressed as the percentage ratio of the vertical distance from the posterior acromion angle to the midpoint of the olecranon process. By using the same reference line as that used for cadaveric dissection, the safe injection zone away from the neurovascular bundle was identified in 6 healthy volunteers via ultrasonography. We identified the neurovascular bundle and its location with respect to the distal end of the humerus and measured its depth from the skin surface. Results The MoEPs for the long, lateral, and medial heads were located at a median of 43.8%, 54.8%, and 60.4% of the length of the reference line in cadaver dissection. The safe injection zone of the medial head MoEPs corresponded to a depth of approximately 3.5 cm from the skin surface and 1.4 cm away from the humerus, as determined by sonography. Conclusion Correct identification of the motor points for each head of the triceps brachii would increase the precision and efficacy of motor point injections to manage elbow extensor spasticity.
Collapse
|
23
|
López de Munain L, Valls-Solé J, Garcia Pascual I, Maisonobe P. Botulinum Toxin Type A Improves Function According to Goal Attainment in Adults with Poststroke Lower Limb Spasticity in Real Life Practice. Eur Neurol 2019; 82:1-8. [PMID: 31726452 DOI: 10.1159/000503172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/03/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Botulinum toxin type A (BoNT-A) is an effective and well-tolerated treatment for adult lower limb spasticity. However, data are inadequate to determine BoNT-A efficacy for active function. This study evaluated functional goal achievement (measured by goal attainment scaling [GAS]) following lower limb BoNT-A injection in clinical practice. METHODS Phase 4, postmarketing, multicenter, prospective, observational study (NCT01444794) in adults with poststroke lower limb spasticity receiving one BoNT-A injection cycle. Assessments were at baseline (pretreatment), 1 month ±7 days (visit 1), and 3-5 months posttreatment (visit 2). Primary outcome measure was GAS; additional assessments included Modified Ashworth Scale, Demeurisse Motricity Index, 10-meter walk test, and Disability Assessment Scale. RESULTS Of 100 enrolled patients, 94 completed the study. Most common primary treatment goals at baseline were improving mobility (57.5%) and positioning (18.1%). At visit 2, 88.3% achieved their primary goal; 87.0% (n = 47/54) for mobility, and 100.0% (n = 17/17) for positioning. In total, 79.1% of patients achieved their secondary goals. Two factors were predictive of primary goal achievement: time since stroke onset (OR 0.907; 95% CI 0.827-0.995; p = 0.038); and absence of stiff knee spasticity pattern (OR 0.228; 95% CI 0.057-0.911; p = 0.036). All functional scales showed improvements; walking speed (mean [SD]) improved by 0.06 (0.13) and 0.05 (0.20) m/s at visits 1 and 2, respectively. CONCLUSIONS BoNT-A injection for lower limb spasticity led to high goal achievement rates in patient-centered GAS evaluation and functional and symptomatic improvements. BoNT-A may therefore deliver clinically meaningful functional improvements in real-life practice.
Collapse
Affiliation(s)
- Lourdes López de Munain
- Department of Rehabilitation, Hospital Universitario Marqués de Valdecilla, Santander, Spain,
| | - Josep Valls-Solé
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | | | | |
Collapse
|
24
|
Management of Spastic Paresis and Cervical Dystonia: Access to Therapeutic Innovations Through an International Program of Practical Courses. Clin Ther 2019; 41:2321-2330.e4. [PMID: 31607560 DOI: 10.1016/j.clinthera.2019.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 08/20/2019] [Accepted: 09/16/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Our purpose was to determine satisfaction and confidence of the Ixcellence Network training program on health care practitioners using botulinum toxin A (BoNT-A) for neurologic disorders, including spastic paresis and cervical dystonia. METHODS The Ixcellence Network training program was designed by a scientific committee of 6 experts and then tested at centers in Europe, and Latin America. The training, provided by 16 experienced neurologists and rehabilitation specialists, consisted of theoretic and practical sessions that covered the different stages of the patient's journey from diagnosis to tailored treatment and rehabilitation. Trainees' feedback and the impact on participants' practice were evaluated by 2 individual questionnaires, at the end of the session (T0) and at 6 months (T6). Trainers' feedback was also collected through an individual questionnaire. FINDINGS Between September 2012 and December 2017, 728 trained physicians participated in training programs with 48%, 23%, and 29% of attendees participating in training sessions dedicated to adult spastic paresis, child spastic paresis, and cervical dystonia, respectively. At T0, 93% of attendees thought that they had been given new information and 90% thought that the training would change their daily practice. This was confirmed at T6 by 93% of respondents. Trainees were highly satisfied with the program, in particular with the practical sessions. Trainers expectations were met for attendees' level of expertise, motivation, language, and participation. IMPLICATIONS In this descriptive study, we show that the Ixcellence Network program represents a new educational approach to promote consistency in care practices and dissemination of expertise on the use of BoNT-A for neurologic disorders.
Collapse
|
25
|
Palazón-García R, Alcobendas-Maestro M, Esclarin-de Ruz A, Benavente-Valdepeñas AM. Treatment of spasticity in spinal cord injury with botulinum toxin. J Spinal Cord Med 2019; 42:281-287. [PMID: 29869974 PMCID: PMC6522928 DOI: 10.1080/10790268.2018.1479053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
CONTEXT Spasticity is one of the most frequent complications in spinal cord injury (SCI), and is routinely managed with oral pharmacologic therapy. Botulinum toxin (BT) is not accepted as a treatment for spasticity in SCI in Spain but may be used in certain cases of focal distribution. OBJECTIVE To report the results with BT for treatment of spasticity in SCI. DESIGN AND SETTING Descriptive retrospective study conducted at a specialist SCI rehabilitation center in Spain, covering patients first treated from 2012 through 2014, and successfully followed up for a minimum of 1 year. Data were collected on the following variables: demographic and SCI characteristics (level and grade); nature of spasticity, e.g. tone, distribution, spasms, articular involvement and pain; function; application of BT; tolerance and adverse reactions. RESULTS The study covered 90 patients, predominantly male with incomplete injuries. Improvement in tone as measured by the modified Ashworth scale was a mean of 1.17 points. Goniometric improvement was achieved in 65.6% and improvement in pain in 38.9% of cases. There were no adverse side-effects. Patients with focal spasticity showed a significantly greater improvement in tone (P < 0.0001). The earlier the BT injection, the greater the improvement in goniometric performance (P < 0.006) and pain (P < 0.033), with the best results being obtained within the first 6 months of clinical course. ASIA D injuries showed a greater improvement in tone (P < 0.0001). CONCLUSIONS BT can be both an effective treatment for focal spasticity in SCI and a good coadjuvant for oral treatments in generalized spasticity.
Collapse
Affiliation(s)
- Ramiro Palazón-García
- Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Toledo, Spain
| | - Mónica Alcobendas-Maestro
- Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Toledo, Spain
| | - Ana Esclarin-de Ruz
- Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Toledo, Spain
| | | |
Collapse
|
26
|
Paulson A, Zigler CK, Houtrow A, Pruitt D. Botulinum Toxin: Techniques Within Pediatric Physiatry. PM R 2019; 11:38-44. [DOI: 10.1016/j.pmrj.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Andrea Paulson
- Department of Pediatrics; University of Cincinnati College of Medicine; Cincinnati OH 45267; Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Christina K. Zigler
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh; Pittsburgh PA
| | - Amy Houtrow
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh; Pittsburgh PA
| | - David Pruitt
- Department of Pediatrics; University of Cincinnati College of Medicine; Cincinnati OH; Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
27
|
Sekiguchi A, Motegi SI, Uchiyama A, Uehara A, Fujiwara C, Yamazaki S, Perera B, Nakamura H, Ogino S, Yokoyama Y, Akai R, Iwawaki T, Ishikawa O. Botulinum toxin B suppresses the pressure ulcer formation in cutaneous ischemia-reperfusion injury mouse model: Possible regulation of oxidative and endoplasmic reticulum stress. J Dermatol Sci 2018; 90:144-153. [PMID: 29402605 DOI: 10.1016/j.jdermsci.2018.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 12/22/2017] [Accepted: 01/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND We previously identified that botulinum toxin A (BTX-A) suppressed pressure ulcer (PU) formation after cutaneous ischemia-reperfusion (I/R) injury; however, regulation of cutaneous I/R-induced oxidative and endoplasmic reticulum (ER) stress by BTX-B was not investigated. Additionally, the efficacy of BTX-B injection has never been examined. OBJECTIVE Objective was to assess the effects of BTX-B on the formation of PU by cutaneous I/R injury, and the regulation of oxidative and ER stress in I/R injury by BTX-B. METHODS BTX-B was subcutaneously injected into I/R area, and wound size, vascular damage, hypoxic area, and apoptotic cells in I/R area were analyzed. We evaluated the extent of oxidative and ER stress in I/R area by using OKD48 mice and ERAI mice, respectively, which enabled evaluating oxidative and ER stress through bioluminescence detection. RESULTS BTX-B injection significantly suppressed the formation of PU by cutaneous I/R injury. Cutaneous I/R-induced vascular damage, hypoxic area, and number of oxidative-damaged cells and apoptotic cells were suppressed by BTX-B injection. BTX-B administration significantly inhibited I/R-induced oxidative stress signal in OKD48 mice. BTX-B reduced the I/R-induced oxidative stress-associated factors. BTX-B significantly inhibited the oxidant-induced reactive oxygen species and apoptosis of endothelial cells and fibroblasts. BTX-B significantly inhibited I/R-induced ER stress signal in ERAI mice. Cutaneous I/R injury-induced ER stress-response factors and GRP78/BiP and CHOP-positive cells in I/R area were significantly decreased by BTX-B injection. CONCLUSION BTX-B injection might have protective effects against PU formation after cutaneous I/R injury by reducing vascular damage, hypoxia-induced oxidative and ER stress, and apoptosis.
Collapse
Affiliation(s)
- Akiko Sekiguchi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Akihiko Uchiyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihito Uehara
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Chisako Fujiwara
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sahori Yamazaki
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Buddhini Perera
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideharu Nakamura
- Division of Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sachiko Ogino
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoko Yokoyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ryoko Akai
- Division of Cell Medicine, Department of Life Science, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Takao Iwawaki
- Division of Cell Medicine, Department of Life Science, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|
28
|
Traditional Uses of Cannabinoids and New Perspectives in the Treatment of Multiple Sclerosis. MEDICINES 2018; 5:medicines5030091. [PMID: 30111755 PMCID: PMC6164967 DOI: 10.3390/medicines5030091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 12/24/2022]
Abstract
Recent findings highlight the emerging role of the endocannabinoid system in the control of symptoms and disease progression in multiple sclerosis (MS). MS is a chronic, immune-mediated, demyelinating disorder of the central nervous system with no cure so far. It is widely reported in the literature that cannabinoids might be used to control MS symptoms and that they also might exert neuroprotective effects and slow down disease progression. This review aims to give an overview of the principal cannabinoids (synthetic and endogenous) used for the symptomatic amelioration of MS and their beneficial outcomes, providing new potentially possible perspectives for the treatment of this disease.
Collapse
|
29
|
Eftekhar A, Norton JJS, McDonough CM, Wolpaw JR. Retraining Reflexes: Clinical Translation of Spinal Reflex Operant Conditioning. Neurotherapeutics 2018; 15:669-683. [PMID: 29987761 PMCID: PMC6095771 DOI: 10.1007/s13311-018-0643-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Neurological disorders, such as spinal cord injury, stroke, traumatic brain injury, cerebral palsy, and multiple sclerosis cause motor impairments that are a huge burden at the individual, family, and societal levels. Spinal reflex abnormalities contribute to these impairments. Spinal reflex measurements play important roles in characterizing and monitoring neurological disorders and their associated motor impairments, such as spasticity, which affects nearly half of those with neurological disorders. Spinal reflexes can also serve as therapeutic targets themselves. Operant conditioning protocols can target beneficial plasticity to key reflex pathways; they can thereby trigger wider plasticity that improves impaired motor skills, such as locomotion. These protocols may complement standard therapies such as locomotor training and enhance functional recovery. This paper reviews the value of spinal reflexes and the therapeutic promise of spinal reflex operant conditioning protocols; it also considers the complex process of translating this promise into clinical reality.
Collapse
Affiliation(s)
- Amir Eftekhar
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA.
| | - James J S Norton
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Christine M McDonough
- School of Health and Rehabilitation Services, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan R Wolpaw
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA
- Department of Neurology, Stratton VA Medical Center, Albany, NY, USA
| |
Collapse
|
30
|
Functional outcomes following ultrasound-guided botulinum toxin type A injections to reduce spastic equinovarus in adult post-stroke patients. Toxicon 2018. [DOI: 10.1016/j.toxicon.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
31
|
Giacoppo S, Bramanti P, Mazzon E. Sativex in the management of multiple sclerosis-related spasticity: An overview of the last decade of clinical evaluation. Mult Scler Relat Disord 2017; 17:22-31. [DOI: 10.1016/j.msard.2017.06.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/20/2017] [Accepted: 06/25/2017] [Indexed: 01/28/2023]
|
32
|
Karakkattil P, Trudelle-Jackson E, Brown HH, Hammontree P, Okolo M. Outcomes of Botulinum Toxin Type A for equinovarus deformity in patients with CVA: A case series. Physiother Theory Pract 2017; 33:410-419. [PMID: 28481738 DOI: 10.1080/09593985.2017.1318420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is evidence that Botulinum Toxin-A (BTX-A) reduces focal spasticity associated with equinovarus to improve gait in patients poststroke. However, there is little research examining whether gait improvements are maintained after the effectiveness period of BTX-A injections. The purpose of this observational study was to determine whether there was a difference in gait parameters in three patients before BTX-A injection versus four and ten weeks after. CASE SERIES Three women, ages 63, 60, and 42 postischemic stroke with hemiparesis and equinovarus underwent measurements for: plantar flexor spasticity, ankle dorsiflexion ROM, temporal-spatial gait parameters, and gait endurance. All participants improved in ankle ROM. At week 10, spasticity had returned to initial measurement levels in participants A and C. Base of support and step length symmetry ratios did not improve following injections. Participants A and B, who received physical therapy during the study, showed modest gains in gait endurance and velocity. CONCLUSION Although BTX-A injections improved spasticity, this improvement did not translate to gait outcomes. Addition of physical therapy interventions appeared to improve gait outcomes in this case series. We suggest future randomized control studies to compare effects of physical therapy alone to BTX-A combined with physical therapy on gait outcomes.
Collapse
Affiliation(s)
- Priya Karakkattil
- a Baylor Institute for Rehabilitation , Outpatient Rehabilitation Services , Frisco , TX , USA.,b School of Physical Therapy , Texas Woman's University , Dallas , TX , USA
| | | | | | - Patrick Hammontree
- b School of Physical Therapy , Texas Woman's University , Dallas , TX , USA
| | - Mary Okolo
- b School of Physical Therapy , Texas Woman's University , Dallas , TX , USA
| |
Collapse
|
33
|
Choi K, Peters J, Tri A, Chapman E, Sasaki A, Ismail F, Boulias C, Reid S, Phadke CP. Goals Set by Patients Using the ICF Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution. Physiother Can 2017; 69:113-119. [PMID: 28539691 DOI: 10.3138/ptc.2016-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Goal Attainment Scaling (GAS) is used to assess functional gains in response to treatment. Specific characteristics of the functional goals set by individuals receiving botulinum toxin type A (BoNTA) injections for spasticity management are unknown. The primary objectives of this study were to describe the characteristics of the goals set by patients before receiving BoNTA injections using the International Classification of Functioning, Disability and Health (ICF) and to determine whether the pattern of spasticity distribution affected the goals set. Methods: A cross-sectional retrospective chart review was carried out in an outpatient spasticity-management clinic in Toronto. A total of 176 patients with a variety of neurological lesions attended the clinic to receive BoNTA injections and completed GAS from December 2012 to December 2013. The main outcome measures were the characteristics of the goals set by the participants on the basis of ICF categories (body functions and structures, activity and participation) and the spasticity distribution using Modified Ashworth Scale scores. Results: Of the patients, 73% set activity and participation goals, and 27% set body functions and structures goals (p<0.05). In the activity and participation category, 30% of patients set moving and walking goals, 28% set self-care and dressing goals, and 12% set changing and maintaining body position goals. In the body functions and structures category, 18% set neuromuscular and movement-related goals, and 8% set pain goals. The ICF goal categories were not related to the patterns of spasticity (upper limb vs. lower limb or unilateral vs. bilateral spasticity) or type of upper motor neuron (UMN) lesion (p>0.05). Conclusion: Our results show that patients receiving BoNTA treatment set a higher percentage of activity and participation goals than body functions and structures goals. Goal classification was not affected by type of spasticity distribution or type of UMN disorder.
Collapse
Affiliation(s)
| | | | | | | | - Ayako Sasaki
- Spasticity Research Program, West Park Healthcare Centre, Toronto
| | - Farooq Ismail
- Spasticity Research Program, West Park Healthcare Centre, Toronto.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto
| | - Chris Boulias
- Spasticity Research Program, West Park Healthcare Centre, Toronto.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto
| | - Shannon Reid
- Department of Physical Therapy.,Spasticity Research Program, West Park Healthcare Centre, Toronto
| | - Chetan P Phadke
- Department of Physical Therapy.,Spasticity Research Program, West Park Healthcare Centre, Toronto.,Faculty of Health, York University
| |
Collapse
|
34
|
Brændvik SM, Roeleveld K, Andersen GL, Raftemo AER, Ramstad K, Majkic-Tajsic J, Lamvik T, Lund B, Follestad T, Vik T. The WE-Study: does botulinum toxin A make walking easier in children with cerebral palsy?: Study protocol for a randomized controlled trial. Trials 2017; 18:58. [PMID: 28166806 PMCID: PMC5294730 DOI: 10.1186/s13063-016-1772-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intramuscular injections of botulinum toxin A (BoNT-A) have been a cornerstone in the treatment of spasticity for the last 20 years. In Norway, the treatment is now offered to two out of three children with spastic cerebral palsy (CP). However, despite its common use, the evidence for its functional effects is limited and inconclusive. The objective of this study is to determine whether BoNT-A makes walking easier in children with CP. We hypothesize that injections with BoNT-A in the calf muscles will reduce energy cost during walking, improve walking capacity, increase habitual physical activity, reduce pain and improve self-perceived performance and satisfaction. METHODS/DESIGN This randomized, double-blinded, placebo-controlled, multicenter trial is conducted in a clinical setting involving three health regions in Norway. Ninety-six children with spastic CP, referred for single-level injections with BoNT-A in the calf muscles, will be invited to participate. Those who are enrolled will be randomized to receive either injections with BoNT-A (Botox®) or 0.9% saline in the calf muscles. Stratification according to age and study center will be made. The allocation ratio will be 1:1. Main inclusion criteria are (1) age 4 - 17.5 years, (2) Gross Motor Function Classification System levels I and II, (3) no BoNT-A injections in the lower limbs during the past 6 months and (4) no orthopedic surgery to the lower limbs during the past 2 years. The outcome measures will be made at baseline and 4, 12 (primary endpoint) and 24 weeks after injections. Primary outcome is change in energy cost during walking. Secondary outcomes are change in walking capacity, change in activity, perceived change in performance and satisfaction in mobility tasks, and pain. The primary analysis will use a linear mixed model to test for difference in change in the outcome measures between the groups. The study is approved by the Regional Ethical Committee and The Norwegian Medicines Agency. Recruitment started in September 2015. DISCUSSION The evaluation of effect is comprehensive and includes objective standardized tests and measures on both impairment and activity level. Results are to be expected by spring 2019. TRIAL REGISTRATION ClinicalTrials.gov, NCT02546999 . Registered on 9 September 2015.
Collapse
Affiliation(s)
- Siri Merete Brændvik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Clinical Services, St. Olav’s University Hospital, Trondheim, Norway
| | - Karin Roeleveld
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Guro Lillemoen Andersen
- Children’s Center, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Kjersti Ramstad
- Department of Clinical Neurosciences for children, Oslo University Hospital, Oslo, Norway
| | - Jasmina Majkic-Tajsic
- Division of Child and Adolescents Health, University Hospital of North Norway, Tromsø, Norway
| | - Torarin Lamvik
- Department of Orthopedics, St. Olav’s University Hospital, Trondheim, Norway
| | - Bendik Lund
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Pediatrics, St. Olav’s University Hospital, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and General Practice, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Torstein Vik
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| |
Collapse
|
35
|
Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force. J Neurol 2016; 264:112-120. [PMID: 27787630 DOI: 10.1007/s00415-016-8304-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
Botulinum toxin (BT) therapy is an established treatment of spasticity due to stroke. For multiple sclerosis (MS) spasticity this is not the case. IAB-Interdisciplinary Working Group for Movement Disorders formed a task force to explore the use of BT therapy for treatment of MS spasticity. A formalised PubMed literature search produced 55 publications (3 randomised controlled trials, 3 interventional studies, 11 observational studies, 2 case studies, 35 reviews, 1 guideline) all unanimously favouring the use of BT therapy for MS spasticity. There is no reason to believe that BT should be less effective and safe in MS spasticity than it is in stroke spasticity. Recommendations include an update of the current prevalence of MS spasticity and its clinical features according to classifications used in movement disorders. Immunological data on MS patients already treated should be analysed with respect to frequencies of MS relapses and BT antibody formation. Registration authorities should expand registration of BT therapy for spasticity regardless of its aetiology. MS specialists should consider BT therapy for symptomatic treatment of spasticity.
Collapse
|
36
|
Caiafa RC, Orsini M, Felicio LR, Puccioni-Sohler M. Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:280-6. [PMID: 27096999 DOI: 10.1590/0004-282x20160019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 11/30/2015] [Indexed: 11/22/2022]
Abstract
UNLABELLED HTLV-1-associated myelopathy is a progressive disabling disease associated with gait abnormalities. OBJECTIVE To identify and quantify the main muscles affected by weakness and spasticity, their impact on gait, functional capacity and on quality of life of HTLV-1-associated myelopathy patients. METHOD We evaluated lower limbs muscular strength according to the Medical Research Council scale, spasticity according to the modified Ashworth scale, daily activities according to the Barthel Index and quality of life according to the Short-Form Health Survey-36 of 26 HTLV-1-associated myelopathy patients. RESULTS The muscles most affected by weakness included the dorsal flexors and knee flexors. Spasticity predominated in the hip adductor muscles and in plantar flexors. Assistance for locomotion, minimal dependence in daily activities, limitations in functional capacity and physical aspects were the most common findings. CONCLUSION The impairment of gait, functional dependence and quality of life were predominantly a consequence of intense muscle weakness in HTLV-1-associated myelopathy patients.
Collapse
Affiliation(s)
| | - Marco Orsini
- Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil
| | - Lilian R Felicio
- Faculdade de Fisioterapia, Universidade Federal de Uberlândia, Uberlandia, MG, Brazil
| | | |
Collapse
|
37
|
Jalaleddini K, Tehrani ES, Kearney RE. A Subspace Approach to the Structural Decomposition and Identification of Ankle Joint Dynamic Stiffness. IEEE Trans Biomed Eng 2016; 64:1357-1368. [PMID: 28113221 DOI: 10.1109/tbme.2016.2604293] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this paper is to present a structural decomposition subspace (SDSS) method for decomposition of the joint torque to intrinsic, reflexive, and voluntary torques and identification of joint dynamic stiffness. METHODS First, it formulates a novel state-space representation for the joint dynamic stiffness modeled by a parallel-cascade structure with a concise parameter set that provides a direct link between the state-space representation matrices and the parallel-cascade parameters. Second, it presents a subspace method for the identification of the new state-space model that involves two steps: 1) the decomposition of the intrinsic and reflex pathways and 2) the identification of an impulse response model of the intrinsic pathway and a Hammerstein model of the reflex pathway. RESULTS Extensive simulation studies demonstrate that SDSS has significant performance advantages over some other methods. Thus, SDSS was more robust under high noise conditions, converging where others failed; it was more accurate, giving estimates with lower bias and random errors. The method also worked well in practice and yielded high-quality estimates of intrinsic and reflex stiffnesses when applied to experimental data at three muscle activation levels. CONCLUSION The simulation and experimental results demonstrate that SDSS accurately decomposes the intrinsic and reflex torques and provides accurate estimates of physiologically meaningful parameters. SIGNIFICANCE SDSS will be a valuable tool for studying joint stiffness under functionally important conditions. It has important clinical implications for the diagnosis, assessment, objective quantification, and monitoring of neuromuscular diseases that change the muscle tone.
Collapse
|
38
|
Lin YC, Lin IL, Chou TFA, Lee HM. Quantitative evaluation for spasticity of calf muscle after botulinum toxin injection in patients with cerebral palsy: a pilot study. J Neuroeng Rehabil 2016; 13:25. [PMID: 26969526 PMCID: PMC4788868 DOI: 10.1186/s12984-016-0135-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 03/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background Cerebral palsy (CP) is the most common pediatric disease to cause motor disability. Two common symptoms in CP are spasticity and contracture. If this occurred in the ankle plantar flexors of children with CP, it will impair their gait and active daily living profoundly. Most children with CP receive botulinum toxin type A (BoNT-A) injection to reduce muscle tone, but a knowledge gap exists in the understanding of changes of neural and non-neural components of spasticity after injection. The purpose of this study was to determine if our device for quantitative modified Tardieu approach (QMTA) is a valid method to assess spasticity of calf muscles after botulinum toxin injection. Methods In this study, we intended to develop a device for quantitative measurement of spasticity in calf muscles based on the modified Tardieu scale (MTS) and techniques of biomedical engineering. Our QMTA measures the angular displacement and resistance of stretched joint with a device that is light, portable and can be operated similar to conventional approaches for MTS. The static (R2), dynamic (R1) and R2-R1 angles derived from the reactive signals collected by the miniature sensors are used to represent the non-neural and neural components of stretched spastic muscles. Four children with CP were recruited to assess the change in spasticity in their gastrocnemius muscles before and 4 weeks after BoNT-A injection. Results A simulated ankle model validated the performance of our device in measuring joint displacement and estimating the angle of catch. Data from our participants with CP showed that R2 and R2-R1 improved significantly after BoNT-A administration. It indicates both neural and non-neural components of the spastic gastrocnemius muscles improved at four weeks after BoNT-A injection in children with CP. Conclusion Our device for QMTA can objectively measure the changes in spasticity of the gastrocnemius muscle in children with cerebral palsy after BoNT-A injection.
Collapse
Affiliation(s)
- Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.,Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan
| | - I-Ling Lin
- Department of Medical Laboratory Sciences and Biotechnology, Kaohsiung Medical University, No 100, Shih-Chuan 1st Road, Kaohsiung City, 80708, Taiwan
| | - Te-Feng Arthur Chou
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.,School of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan
| | - Hsin-Min Lee
- Department of Physical Therapy, I-Shou University, No.8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan, ROC.
| |
Collapse
|
39
|
Wu T, Li JH, Song HX, Dong Y. Effectiveness of Botulinum Toxin for Lower Limbs Spasticity after Stroke: A Systematic Review and Meta-Analysis. Top Stroke Rehabil 2016; 23:217-23. [DOI: 10.1080/10749357.2016.1139294] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
40
|
Dai AI, Aksoy SN, Demiryürek AT. Comparison of Efficacy and Side Effects of Oral Baclofen Versus Tizanidine Therapy with Adjuvant Botulinum Toxin Type A in Children With Cerebral Palsy and Spastic Equinus Foot Deformity. J Child Neurol 2016; 31:184-9. [PMID: 25999301 DOI: 10.1177/0883073815587030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/21/2015] [Indexed: 11/15/2022]
Abstract
This retrospective study aimed to compare the therapeutic response, including side effects, for oral baclofen versus oral tizanidine therapy with adjuvant botulinum toxin type A in a group of 64 pediatric patients diagnosed with static encephalopathy and spastic equinus foot deformity. Following botulinum toxin A treatment, clinical improvement led to the gradual reduction of baclofen or tizanidine dosing to one-third of the former dose. Gross Motor Functional Measure and Caregiver Health Questionnaire scores were markedly elevated post-botulinum toxin A treatment, with scores for the tizanidine (Gross Motor Functional Measure: 74.45 ± 3.72; Caregiver Health Questionnaire: 72.43 ± 4.29) group significantly higher than for the baclofen group (Gross Motor Functional Measure: 68.23 ± 2.66; Caregiver Health Questionnaire: 67.53 ± 2.67, P < .001). These findings suggest that the combined use of botulinum toxin A and a low dose of tizanidine in treating children with cerebral palsy appears to be more effective and has fewer side effects versus baclofen with adjuvant botulinum toxin A.
Collapse
Affiliation(s)
- Alper I Dai
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Neurology, University of Gaziantep, Gaziantep, Turkey
| | - Sefika N Aksoy
- Department of Biochemistry, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Abdullah T Demiryürek
- Department of Medical Pharmacology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| |
Collapse
|
41
|
Santamato A. Safety and efficacy of incobotulinumtoxinA as a potential treatment for poststroke spasticity. Neuropsychiatr Dis Treat 2016; 12:251-63. [PMID: 26869793 PMCID: PMC4737345 DOI: 10.2147/ndt.s86978] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Spasticity is a common disabling symptom for several neurological conditions. Botulinum toxin type A injection represents the gold standard treatment for focal spasticity after stroke showing efficacy, reversibility, and low prevalence of complications. In recent years, incobotulinumtoxinA, a new Botulinum toxin type A free of complexing proteins, has been used for treating several movement disorders with safety and efficacy. IncobotulinumtoxinA is currently approved for treating spasticity of the upper limb in stroke survivors, even if several studies described the use also in lower limb muscles. In the present review article, we examine the safety and effectiveness of incobotulinumtoxinA for the treatment of spasticity after stroke.
Collapse
Affiliation(s)
- Andrea Santamato
- Physical Medicine and Rehabilitation Section, "OORR Hospital," University of Foggia, Foggia, Italy
| |
Collapse
|
42
|
Mullins D, Winter A, Fini N, Dixon C, Aldous S, Palit M, Holland AE. Frequency and characteristics of goal attainment following BoNT-A injection for management of spasticity. Disabil Rehabil 2015; 38:1927-33. [PMID: 26714558 DOI: 10.3109/09638288.2015.1107781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine which Goal Attainment Scale (GAS) goals are commonly achieved in patients with upper limb and/or lower limb spasticity following Botulinum Neurotoxin Type A (BoNT-A) injection. METHOD Adults who attended a Spasticity Management Clinic for upper and/or lower limb BoNT-A injection were included in this prospective cohort study. Goals were set by participants and/or carers in conjunction with the therapist using the GAS, prior to injection and reviewed at one month following the injection. Three out of the five categories of goals were passive. Goals were categorised into: mobility/transfers, pain/comfort, upper limb use, hygiene, and cosmesis. The number of responders for the GAS total score, and in each of the GAS categories, was calculated. RESULTS Sixty-seven participants were recruited (mean age 51 ± 16 years; range 18-85), 70% had a stroke. Responders for mobility and transfer goals were further post injury or disease onset than non-responders (median 5.9 vs. 1.2 years, p = 0.03). Clients with stroke were less likely than other participants to achieve mobility and transfer goals (p = 0.02). There was a trend for those who achieved mobility and transfer goals to be younger (mean 49 years vs. 55 years, p = 0.06). Although active goals are more commonly identified, passive goals were more likely to be achieved. CONCLUSIONS Although active goals are commonly identified by people with spasticity, passive goals were more likely to be achieved following BoNT-A injection. A long duration of spasticity does not preclude patients from achieving mobility and transfer goals. Non-stroke participants were more likely to achieve mobility and transfer goals. Implications for Rehabilitation Patients with chronic spasticity should be considered for BoNT-A as clinically meaningful outcomes can be achieved. When spasticity is present in multiple muscles, the GAS can be an assistive tool to guide clinicians in determining which muscles are a priority for injection, because the client will be more motivated to improve those specific goals. Although carers and patients are more willing to set active goals, these are more difficult to achieve possibly because follow up intervention or independent practise is required.
Collapse
Affiliation(s)
- Denita Mullins
- a Occupational Therapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia
| | - Adele Winter
- b Physiotherapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia
| | - Natalie Fini
- b Physiotherapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia ;,c Acquired Brain Injury Centre , Caulfield Hospital, Alfred Health , Caulfield , Australia
| | - Caroline Dixon
- a Occupational Therapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia
| | | | - Mithu Palit
- c Acquired Brain Injury Centre , Caulfield Hospital, Alfred Health , Caulfield , Australia
| | - Anne E Holland
- b Physiotherapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia ;,e La Trobe University , Bundoora , Australia
| |
Collapse
|
43
|
Chang CL, Weber DJ, Munin MC. Changes in Cerebellar Activation After Onabotulinumtoxin A Injections for Spasticity After Chronic Stroke: A Pilot Functional Magnetic Resonance Imaging Study. Arch Phys Med Rehabil 2015; 96:2007-16. [PMID: 26239302 PMCID: PMC4628596 DOI: 10.1016/j.apmr.2015.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 06/17/2015] [Accepted: 07/07/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the effect of reducing spasticity via onabotulinumtoxin A (Obtx-A) injection on cerebellar activation after chronic stroke during unilateral gripping. DESIGN Pre-post, case series. SETTING Outpatient spasticity clinic. PARTICIPANTS Individuals with chronic spasticity (N=4). INTERVENTIONS Upper-limb Obtx-A injection. MAIN OUTCOME MEASURES Functional magnetic resonance imaging (fMRI) was used to measure changes in cerebellar activation before and after upper-limb Obtx-A injection. During fMRI testing, participants performed the same motor task before and after injection, which was 15% and 30% of maximum voluntary isometric gripping measured before Obtx-A injection. RESULTS After Obtx-A injection, cerebellar activation increased bilaterally during gripping with the paretic hand and during rest. During both pre- and postinjection scans, the paretic hand showed larger cerebellar activation during gripping compared with the nonparetic hand. Cerebellar activation during gripping with the nonparetic hand did not change significantly after Obtx-A injection. CONCLUSIONS Reducing spasticity via Obtx-A injection may increase cerebellar activation both during gripping tasks with the paretic hand and during rest. To our knowledge, this is the first study that examines changes in cerebellar activation after spasticity treatment with Obtx-A.
Collapse
Affiliation(s)
- Chia-Lin Chang
- Department of Kinesiology, University of San Francisco, San Francisco, CA.
| | | | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
44
|
Gourab K, Schmit BD, Hornby TG. Increased Lower Limb Spasticity but Not Strength or Function Following a Single-Dose Serotonin Reuptake Inhibitor in Chronic Stroke. Arch Phys Med Rehabil 2015; 96:2112-9. [PMID: 26376447 DOI: 10.1016/j.apmr.2015.08.431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the effects of single doses of a selective serotonin reuptake inhibitor (SSRI) on lower limb voluntary and reflex function in individuals with chronic stroke. DESIGN Double-blind, randomized, placebo-controlled crossover trial. SETTING Outpatient research setting. PARTICIPANTS Individuals (N=10; 7 men; mean age ± SD, 57±10y) with poststroke hemiplegia of >1 year duration who completed all assessments. INTERVENTIONS Patients were assessed before and 5 hours after single-dose, overencapsulated 10-mg doses of escitalopram (SSRI) or placebo, with 1 week between conditions. MAIN OUTCOME MEASURES Primary assessments included maximal ankle and knee isometric strength, and velocity-dependent (30°/s-120°/s) plantarflexor stretch reflexes under passive conditions, and separately during and after 3 superimposed maximal volitional drive to simulate conditions of increased serotonin release. Secondary measures included clinical measures of lower limb coordination and locomotion. RESULTS SSRI administration significantly increased stretch reflex torques at higher stretch velocities (eg, 90°/s; P=.03), with reflexes at lower velocities enhanced by superimposed voluntary drive (P=.02). No significant improvements were seen in volitional peak torques or in clinical measures of lower limb function (lowest P=.10). CONCLUSIONS Increases in spasticity but not strength or lower limb function were observed with single-dose SSRI administration in individuals with chronic stroke. Further studies should evaluate whether repeated dosing of SSRIs, or as combined with specific interventions, is required to elicit significant benefit of these agents on lower limb function poststroke.
Collapse
Affiliation(s)
- Krishnaj Gourab
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI; Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL
| | - T George Hornby
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL.
| |
Collapse
|
45
|
Strobl W, Theologis T, Brunner R, Kocer S, Viehweger E, Pascual-Pascual I, Placzek R. Best clinical practice in botulinum toxin treatment for children with cerebral palsy. Toxins (Basel) 2015; 7:1629-48. [PMID: 25969944 PMCID: PMC4448165 DOI: 10.3390/toxins7051629] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/29/2015] [Accepted: 05/05/2015] [Indexed: 11/16/2022] Open
Abstract
Botulinum toxin A (BoNT-A) is considered a safe and effective therapy for children with cerebral palsy (CP), especially in the hands of experienced injectors and for the majority of children. Recently, some risks have been noted for children with Gross Motor Classification Scale (GMFCS) of IV and the risks are substantial for level V. Recommendations for treatment with BoNT-A have been published since 1993, with continuous optimisation and development of new treatment concepts. This leads to modifications in the clinical decision making process, indications, injection techniques, assessments, and evaluations. This article summarises the state of the art of BoNT-A treatment in children with CP, based mainly on the literature and expert opinions by an international paediatric orthopaedic user group. BoNT-A is an important part of multimodal management, to support motor development and improve function when the targeted management of spasticity in specific muscle groups is clinically indicated. Individualised assessment and treatment are essential, and should be part of an integrated approach chosen to support the achievement of motor milestones. To this end, goals should be set for both the long term and for each injection cycle. The correct choice of target muscles is also important; not all spastic muscles need to be injected. A more focused approach needs to be established to improve function and motor development, and to prevent adverse compensations and contractures. Furthermore, the timeline of BoNT-A treatment extends from infancy to adulthood, and treatment should take into account the change in indications with age.
Collapse
Affiliation(s)
- Walter Strobl
- Department of Paediatric- and Neuro-Orthopaedics, Orthopaedic Hospital Rummelsberg, 90592 Schwarzenbruck, Germany and MOTIO, 1080 Vienna, Austria.
| | - Tim Theologis
- Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road Headington, Oxford OX3 7LD, Oxfordshire, UK.
| | - Reinald Brunner
- Department of Paediatric- and Neuro-Orthopaedics, University Children's Hospital Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland.
| | - Serdar Kocer
- Centre de Réadaptation de COUBERT (Ugecam) 77170, France and ROMATEM, Etiler Istanbul 34337, Turkey.
| | - Elke Viehweger
- Pediatric Orthopaedics and Institue of Motion Sciences Department, Aix-Marseille Université, Boulevard Jean Moulin, Marseille 13885, France.
| | - Ignacio Pascual-Pascual
- Department of Paediatrics, Hospital Infantil La Paz, Universidad Autonóma de Madrid, Madrid, Spain.
| | - Richard Placzek
- Orthopedic Department, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| |
Collapse
|
46
|
Cheung J, Rancourt A, Di Poce S, Levine A, Hoang J, Ismail F, Boulias C, Phadke CP. Patient-identified factors that influence spasticity in people with stroke and multiple sclerosis receiving botulinum toxin injection treatments. Physiother Can 2015; 67:157-66. [PMID: 25931667 DOI: 10.3138/ptc.2014-07] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the nature, extent, and impact of spasticity; determine factors that are perceived to influence its severity; and examine the relationship between time since diagnosis and impact of spasticity on daily activities in people with stroke and multiple sclerosis (MS) who are receiving botulinum toxin injection treatments. METHODS After a cross-sectional telephone survey, descriptive statistics and correlations were analyzed separately for the stroke and MS groups. RESULTS A total of 29 people with stroke and 10 with MS were surveyed. Both groups perceived increased spasticity with outdoor cold (69% stroke, 60% MS), muscle fatigue (59% stroke, 80% MS), and mental stress (59% stroke, 90% MS). No statistically significant correlations were found between time since diagnosis and perceived impact of spasticity on function in the stroke (r=0.07, p=0.37) or MS (r=0.16, p=0.33) groups. The MS group experienced bilateral and more severe perception of spasticity in the legs than the stroke group and identified more factors as worsening their spasticity (p<0.05). Severity of leg (but not arm) spasticity was significantly correlated with severity of impact of the following factors in the MS group only: lying on the back (r=0.70, p<0.05), outdoor heat (r=0.61, p<0.05), and morning (r=0.59, p<0.05). CONCLUSION Intrinsic and extrinsic triggers can influence the perception of spasticity differently depending on individual factors, severity, location (arm vs. leg), and distribution of spasticity (unilateral vs. bilateral). Clinicians can use the findings to better understand, educate, and treat people with stroke and MS.
Collapse
Affiliation(s)
| | | | | | | | | | - Farooq Ismail
- Spasticity Research Program, West Park Healthcare Centre ; Division of Physiatry, University of Toronto
| | - Chris Boulias
- Spasticity Research Program, West Park Healthcare Centre ; Division of Physiatry, University of Toronto
| | - Chetan P Phadke
- Department of Physical Therapy ; Spasticity Research Program, West Park Healthcare Centre ; Faculty of Health, York University, Toronto
| |
Collapse
|
47
|
Tao W, Yan D, Li JH, Shi ZH. Gait improvement by low-dose botulinum toxin A injection treatment of the lower limbs in subacute stroke patients. J Phys Ther Sci 2015; 27:759-62. [PMID: 25931725 PMCID: PMC4395709 DOI: 10.1589/jpts.27.759] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/21/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Lower-limb spasticity after stroke may be associated with worse functional outcome. Our study aim was to establish whether a low-dose botulinum toxin A (BTX-A) injection in subacute stroke patients can improve spasticity, gait, and daily living abilities. [Subjects] Twenty-three subacute stroke patients were randomly allocated to BTX-A treatment group (11 patients) and control group (12 patients). [Methods] In the BTX-A treatment group patients, 200 units BTX-A was injected into the triceps surae (150 iu) and posterior tibial (50 iu) by electrical stimulation-guided. The patients in the control group received the same volume of placebo solution into the same injection locations. Gait analysis (step length, cadence, speed), the 6-min walking test, Fugl-Meyer Assessment (FMA) of the lower limbs, modified Ashworth scale assess (MAS) assessment of the lower limbs, surface electromyography (sEMG), and modified Barthel index (MBI) assessment were performed before and at 4,8 weeks after treatment. [Results] We found that the FMA of the low limbs and MBI were significantly improved in both groups. The gait analysis, FMA, and MBI results in the BTX-A treatment group were better than those in the control group. MAS and surface electromyography (sEMG) showed better improvement of spasticity in the treatment group. [Conclusion] Early low-dose botulinum toxin A (BTX-A) injection in subacute stroke patients into the lower-limb may improve gait, spasticity, and daily living abilities.
Collapse
Affiliation(s)
- Wu Tao
- Department of Rehabilitation, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
| | - Dong Yan
- Department of Rehabilitation Medicine, Hangzhou Hospital of Zhejiang CAPF, China
| | - Jian-Hua Li
- Department of Rehabilitation, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
| | - Zhao-Hong Shi
- Department of Rehabilitation, First People's Hospital of Wen-ling, China
| |
Collapse
|
48
|
Abstract
An operant-conditioning protocol that bases reward on the electromyographic response produced by a specific CNS pathway can change that pathway. For example, in both animals and people, an operant-conditioning protocol can increase or decrease the spinal stretch reflex or its electrical analog, the H-reflex. Reflex change is associated with plasticity in the pathway of the reflex as well as elsewhere in the spinal cord and brain. Because these pathways serve many different behaviors, the plasticity produced by this conditioning can change other behaviors. Thus, in animals or people with partial spinal cord injuries, appropriate reflex conditioning can improve locomotion. Furthermore, in people with spinal cord injuries, appropriate reflex conditioning can trigger widespread beneficial plasticity. This wider plasticity appears to reflect an iterative process through which the multiple behaviors in the individual's repertoire negotiate the properties of the spinal neurons and synapses that they all use. Operant-conditioning protocols are a promising new therapeutic method that could complement other rehabilitation methods and enhance functional recovery. Their successful use requires strict adherence to appropriately designed procedures, as well as close attention to accommodating and engaging the individual subject in the conditioning process.
Collapse
|
49
|
Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review. Spinal Cord 2015; 53:252-64. [PMID: 25582713 DOI: 10.1038/sc.2014.241] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI). SETTING British Columbia, Canada. METHODS EMBASE, MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched for English language studies published up until March 2014. Studies were assessed for eligibility and quality by two independent reviewers. RESULTS No controlled trials were identified. A total of 19 studies were included: 9 involving BoNT and 10 involving phenol/alcohol. Owing to the clinically diverse nature of the studies, meta-analysis was deemed inappropriate. The studies produced level 4 and level 5 evidence that chemodenervation with BoNT or alcohol/phenol can lead to improvement in outcome measurements classified in the body structure and function, as well as activity domains of the International Classification of Functioning, Disability and Health framework. The Modified Ashworth Scale (MAS) was the most commonly used outcome measure. All six studies on BoNT and three of the four studies on phenol/alcohol measuring MAS reported a decrease in at least one point. An improvement in MAS was not always associated with improvement in function. The effect of phenol/alcohol has the potential to last beyond 6 months; study follow-up did not occur beyond this time point. CONCLUSION Chemodenervation with BoNT or phenol/alcohol may improve spasticity and function in individuals with SCI. However, there is a lack of high-quality evidence and further research is needed to confirm the efficacy of these interventions.
Collapse
|
50
|
Sarcher A, Raison M, Ballaz L, Lemay M, Leboeuf F, Trudel K, Mathieu PA. Impact of muscle activation on ranges of motion during active elbow movement in children with spastic hemiplegic cerebral palsy. Clin Biomech (Bristol, Avon) 2015; 30:86-94. [PMID: 25467763 DOI: 10.1016/j.clinbiomech.2014.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with spastic hemiplegic cerebral palsy are restricted in their daily activities due to limited active ranges of motion of their involved upper limb, specifically at the elbow. Their impaired muscles are frequently targeted by anti-spastic treatments that reduce muscle tone. But these treatments do not necessarily improve the limb function. There is a lack of comprehensive knowledge of the quantitative relations between muscle activation and joint active ranges of motion. Consequently, the objective of this study is to quantify the impact of muscle activation on the elbow active ranges of motion. METHODS During voluntary elbow pronation/supination and extension/flexion movements, kinematic and electromyographic measurements were collected from the involved upper limb of 15 children with spastic hemiplegic cerebral palsy (mean age=8.7 years, standard deviation=2.2) and the dominant upper limb of 15 age-matched children who are typically developing. Representative indicators of the muscle activation, such as the muscle co-activation, were extracted from the electromyographic measurements. FINDINGS Muscle co-activation in the involved upper limb accounted for 78% and 59% of the explained variance of the supination and extension limited active ranges of motion respectively. The agonist and antagonist muscle activations were both longer in the involved upper limb. INTERPRETATIONS This study succeeded in quantifying the impact of longer antagonist muscle activation on decreased elbow active ranges of motion in children with spastic hemiplegic cerebral palsy. Longer agonist muscle activation suggests that strengthening agonist muscles could increase the extension and supination ranges of motion, which constitutes a perspective of future clinical studies.
Collapse
Affiliation(s)
- A Sarcher
- Research Centre, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada; Department of Mechanical Engineering, Polytechnique Montréal, 2500 Chemin de Polytechnique, Montreal, Quebec, Canada.
| | - M Raison
- Research Centre, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada; Department of Mechanical Engineering, Polytechnique Montréal, 2500 Chemin de Polytechnique, Montreal, Quebec, Canada
| | - L Ballaz
- Research Centre, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada; Department of Kinanthropology, Université du Québec à Montréal, C.P. 8888, succursale Centre-Ville, Montreal, Quebec, Canada
| | - M Lemay
- Research Centre, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada; Department of Kinanthropology, Université du Québec à Montréal, C.P. 8888, succursale Centre-Ville, Montreal, Quebec, Canada
| | - F Leboeuf
- Laboratoire d'analyse du Mouvement, Pôle Médecine Physique et Réadaptation, hôpital Saint Jacques, CHU Nantes, Nantes, France
| | - K Trudel
- Marie Enfant Rehabilitation Centre, 5200 Bélanger, Montreal, Quebec, Canada
| | - P A Mathieu
- Research Centre, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada; Institute of Biomedical Engineering, Université de Montréal, 2960 Chemin de la Tour, Montreal, Quebec, Canada
| |
Collapse
|