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1.
Neurol Neurochir Pol ; 55(2): 125-132, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33822352

RESUMO

Cervical dystonia (CD) usually presents a complex pattern of head/neck movements accompanied by tremor, myoclonic jerks and a wide spectrum of non-motor disturbances such as pain, depression, anxiety, and sleep problems. This is the most challenging indication for botulinum neurotoxin (BoNT) treatment. It can offer significant improvement, but it can be difficult after the first injection. Thorough examination and identification of the proper CD pattern, the identification of the muscles responsible, and adjusting doses given precisely under ultrasound and/or electromyographic guidance seem to be the key success modifiers. Nevertheless, this is a lifelong treatment and should be planned and conducted carefully to avoid failures and drop outs. The aim of this paper was to examine the current concepts in terms of anatomy, physiology and CD patterns (Col-Cap concept) as well as the proper dosages and any possible obstacles impeding successful treatment.


Assuntos
Toxinas Botulínicas Tipo A , Toxinas Botulínicas , Torcicolo , Toxinas Botulínicas/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Humanos , Dor , Torcicolo/tratamento farmacológico , Tremor , Ultrassonografia
2.
Neurol Neurochir Pol ; 55(2): 158-164, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33861462

RESUMO

The introduction of botulinum toxin more than 25 years ago for the management of paediatric lower and upper limb hypertonia has been a major advance. BoNT-A as a part of multimodal treatment supports motor development and improves function disturbed by spasticity or hypertonia. The aim of this paper was to compare the efficacy and safety of three major BoNT-A preparations present on the market: abo-, inco-, and onaobotulinumtoxinA in the treatment of children with cerebral palsy. Based on an analysis of the available literature, all three preparations have been established to reduce hypertonia in the upper and lower extremities, with some conflicting evidence regarding function. There were no differences in treatment safety, with a low incidence of adverse events which were mostly temporary and mild. Any form of universal conversion ratio between all preparations is not recommended.


Assuntos
Toxinas Botulínicas Tipo A , Paralisia Cerebral , Fármacos Neuromusculares , Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/tratamento farmacológico , Criança , Humanos , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Resultado do Tratamento
3.
Hautarzt ; 72(5): 393-402, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33822278

RESUMO

Facial rejuvenation is gaining immense popularity among patients and clinicians. Botulinum toxins derived from bacteria are well-tolerated options as minimally invasive interventions for facial rejuvenation or other aesthetic procedures. These products have revolutionized aesthetic treatments. Several types of botulinum toxins (BoNT) are available. Currently type A and B are clinically used and only BoNT­A products are approved for use for cosmetic indications in the Germany and the United States. Each product is unique in terms of its composition. Understanding the various BoNT­A products is essential in choosing the optimal treatment for our patients. In this article we discuss different BoNT­A products used for aesthetic intervention.


Assuntos
Toxinas Botulínicas Tipo A , Técnicas Cosméticas , Dermatologia , Envelhecimento da Pele , Toxinas Botulínicas Tipo A/uso terapêutico , Estética , Alemanha , Humanos , Rejuvenescimento
5.
J Rehabil Med ; 53(2): jrm00157, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33616192

RESUMO

OBJECTIVE: To assess the longitudinal effects of integrated spasticity management incorporating repeated cycles of botulinum toxin A type A (BoNT-A) over 2 years. METHODS: The Upper Limb International Spasticity study was a prospective, observational, cohort study following adult patients over 2 years of integrated upper-limb spasticity management including repeat botulinum toxin (BoNT-A) treatment (any commercially-available product). RESULTS: A total of 1,004 participants from 14 countries were enrolled, of which 953 underwent ≥ 1 BoNT-A injection cycle (median 4 cycles) and had ≥ 1 goal attainment scaling assessment. Most participants (55.9-64.6% across cycles 1-6) saw a therapist after BoNT-A treatment; the most frequent therapy intervention was passive stretch (70.1-79.8% across cycles 1-6). Patients achieved their goals as expected over repeated cycles; mean cumulated goal attainment scaling T-score at 2 years was 49.5 (49.1, 49.9). Mean goal attainment scaling change scores of ≥ 10 were maintained across up to 7 cycles. Higher rates of goal achievement were seen for primary goals related to passive vs active function (86.6% vs 71.4% achievement). Standardized measures of spasticity, pain, involuntary movements, active and passive function improved significantly over the study. CONCLUSION: This large, international study provides evidence for benefit of repeated cycles of BoNT-A, over 2 years captured through person-centred goal attainment and standardized measures.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Extremidade Superior/fisiopatologia , Toxinas Botulínicas Tipo A/farmacologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/uso terapêutico , Estudos Prospectivos , Resultado do Tratamento
6.
Toxins (Basel) ; 13(2)2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33573065

RESUMO

Botulinum neurotoxin type A (BoNT/A) injections have to be administered repeatedly to achieve a rather stable, high level of improvement. This study aimed to take a look at changes in the daily routine of a BoNT/A outpatient clinic due to the SARS-CoV-2 pandemic lockdown, analyze the impact of SARS-CoV-2-induced re-injection delay on outcomes in patients with cervical dystonia (CD) (n = 36) and four other disease entities (n = 58), and study the influence of covariables, including previous injections and doses. For the present observational study, the first 100 patients who were scheduled to have an appointment between April 20 and May 18 during the partial lockdown and also had been treated regularly before the lockdown were recruited. Clinical and demographical characteristics and treatment-related data from the previous visits were extracted from charts. Time delay, symptom severity assessment, and TSUI score (if applicable) were gathered at the first coronavirus pandemic lockdown emergency visit for each patient. Of the 94 patients who could come to the clinic, 48 reported a delay and 44 reported worsening during the delay. Delays ranged from 1 to 63 days, the mean delay was 23 days, and the mean worsening was 26% compared to the previous visit. A significant correlation was found between the duration of the delay and the patient's rating of worsening (PwP). In CD patients, the physician´s rating of CD worsening by the TSUI score (ATUSI-PTSUI) was significantly correlated with general worsening (DwP) and the TSUI at the last visit (PTSUI). A small delay of a few weeks led to a similar worsening of symptoms in CD and all other disease entities and to relapse on a higher level of severity. This relapse can only be compensated by continuous treatment up to at least 1 year until patients reach the same level of treatment efficacy as that before the SARS-CoV-2 pandemic.


Assuntos
Instituições de Assistência Ambulatorial/tendências , Assistência à Saúde/tendências , Pandemias , Quarentena , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/uso terapêutico , Continuidade da Assistência ao Paciente/tendências , Alemanha , Humanos , Fármacos Neuromusculares/administração & dosagem , Fármacos Neuromusculares/uso terapêutico , Tempo para o Tratamento
7.
Medicine (Baltimore) ; 100(1): e23034, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429727

RESUMO

BACKGROUND: Botulinum toxin A injection is an established method of treatment. Clinical practitioners use it widely in their practice to prevent the occurrence of facial scars. However, the effectiveness and safeness of has not been comprehensively established. The objective of the current systematic review is to evaluate the efficacy and safety of using botulinum toxin A injection to improve facial scars. METHODS AND ANALYSIS: This systematic review involves browsing a number of electronic databases to search for related articles. The search will include databases in both English (PubMed, EMBASE, Web of Science, Spocus, and Cochrane Central Register of Controlled Trials) and Chinese (WanFang database, China Nation Knowledge Infrastructure, and VIP database), the periods of searching will be from inception till the 15th of September 2020. Completing the search in databases allows to consider randomized controlled studies that compares botulinum toxin A interventions to any comparison interventions in those who have facial scars. The review will be inclusive of papers in both languages, English and Chinese. The independent screening of studies for eligibility is conducted by 2 independent authors. Discussion was used to resolve discrepancies between the authors. The Cochrane Risk of Bias Tool V.2.0 is adopted for evaluating the methodological quality of each study. Data extraction was performed by 2 independent authors. For dichotomous outcomes, the were expressed as relative risk (RR) with 95% confidence intervals (CI). For continuous outcomes the results were expressed as the mean difference (MD) or standardized mean difference (SMD) with 95% CI. The statistical analysis of the present study is carried out in RevMan 5.3 software. RESULTS: This study will output a comprehensive synthesis of existing evidence in relation to botulinum toxin A. Moreover, the results will also provide an interpretation of the effectiveness and safety of botulinum toxin A. CONCLUSION: The present review contributes to the existing body of knowledge by adding more evidence to evaluate if botulinum toxin A is effective and safe to be used as an intervention for improving facial scars. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/94TXP (https://osf.io/94TXP/).


Assuntos
Toxinas Botulínicas Tipo A/normas , Cicatriz/tratamento farmacológico , Protocolos Clínicos , Face/fisiopatologia , Toxinas Botulínicas Tipo A/efeitos adversos , Toxinas Botulínicas Tipo A/uso terapêutico , Cicatriz/fisiopatologia , Humanos , Injeções/efeitos adversos , Injeções/métodos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
8.
Neurol Neurochir Pol ; 55(2): 174-178, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33471347

RESUMO

AIM OF STUDY: Botulinum neurotoxin type A (BoNT/A) injections are the established treatment in cervical dystonia (CD). But clinical practice regarding the choice of muscles into which injections are made varies between centres. Until now, there have been no dose-per-muscle recommendations based on 'searching the dose' clinical trial data. CLINICAL RATIONALE FOR STUDY: We therefore examined the dosages under real world conditions at seven international movement disorders centres, using an identical clinical approach. RESULTS: We examined 305 patients with CD (55.6 ± 13.2 years, 204 female). The most commonly injected muscles were the splenius capitis (84.9%), sternocleidomastoid (80.3%), trapezius (59.7%), levator scapulae (49.8%), semispinalis capitis (39%), and obliquus capitis inferior (36.7%). The mean total dose per treatment session with aboBoNT/A was 652.5 (SD = 285.5), with onaBoNT/A it was 159.5 (SD = 62.4), and with incoBoNT/A it was 173.4 (SD = 99.2) units. The doses injected into each muscle in the ona- or incoBoNT/A groups were between 19.7 and 48.2 units, with the highest dose for the splenius capitis with 49.2 ± 26.0 units. The doses in the aboBoNT/A group were between 69.6 and 146.4 units, and the highest dose being injected into the splenius capitis (139.6 ± 80.7 units). CONCLUSIONS AND CLINICAL IMPLICATIONS: In clinical trials the doses per muscle are based on an arbitrary decision. In our study, the doses were lower than in other studies, which may be due to the number of muscles per session, the use of ultrasound guidance (and therefore more precise injections), as well as the use of the Col-Cap concept. Our results exemplify everyday practice, and may help as the basis for recommendations and further investigations.


Assuntos
Toxinas Botulínicas Tipo A , Transtornos dos Movimentos , Torcicolo , Toxinas Botulínicas Tipo A/uso terapêutico , Feminino , Humanos , Músculos do Pescoço , Torcicolo/tratamento farmacológico , Ultrassonografia
9.
Neurol Neurochir Pol ; 55(2): 165-173, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33433902

RESUMO

AIM OF THE STUDY: SPACE, a prospective, non-interventional, open-label, multinational study, investigated physicians' and subjects' assessment of safety, efficacy, and health-related quality of life (HRQoL) following botulinum neurotoxin type A (BoNT-A) treatment to understand real-world clinical usage for the management of focal and multifocal spasticity. CLINICAL RATIONALE FOR THE STUDY: Treatment guidelines recommend the use of BoNT-A for the management of spasticity in adults. This study assessed how physicians use BoNT-A therapy in real-world clinical practice, and provided evidence on long-term safety and efficacy over a period of up to 2 years. MATERIALS AND METHODS: BoNT treatment-naïve adults with spasticity of any aetiology received any BoNT-A formulation at their physician's discretion, and were observed for ≤ 8 treatment cycles (≤ 2 years). Daily practice information, physician's global assessments of tolerability and efficacy, and HRQoL were documented. Incidences of adverse drug reactions or all adverse events were documented for non-Mexican subjects and for Mexican subjects, respectively, due to protocol differences based on local regulatory requirements. RESULTS: A total of 701 subjects were enrolled (safety population; nine countries). Physicians rated the tolerability of BoNT-A as 'very good' or 'good' for 88.2-97.4% of subjects throughout the study (subject numbers declined throughout this non-interventional study). Adverse drug reactions were reported for 16/600 (2.7%) of the non-Mexican subjects, with two considered to be 'definitely related' to treatment (injection-site haematoma, n = 1; botulism, n = 1). For 687 subjects, efficacy was rated 'very good' or 'good' by most physicians and subjects. Improvements in HRQoL were observed. CONCLUSIONS AND CLINICAL IMPLICATIONS: Throughout this 2-year study, BoNT-A treatment was generally well-tolerated, effective, and associated with an improved HRQoL. This study makes a valuable contribution to the broader understanding of how physicians use BoNT-A therapy to manage spasticity in real-world clinical practice.


Assuntos
Toxinas Botulínicas Tipo A , Fármacos Neuromusculares , Adulto , Toxinas Botulínicas Tipo A/uso terapêutico , Humanos , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
11.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462041

RESUMO

Masseter hypertrophy (MH) is an uncommon disorder which can cause both aesthetic and functional problems. The most common aetiological factors associated with MH are habit of chewing gum, clenching and/or bruxism. The treatment of MH includes conservative management as well as surgical resection of the enlarged muscle and/or bone. Injection of botulinum toxin type A is a relatively new and minimally invasive method for management of masseter muscle hypertrophy, which offers many advantages over conventional surgical management. This paper reports a case of unilateral MH of unknown origin which was treated with injection of botulinum toxin type A, resulting in satisfactory reduction in the volume of muscle and improvement of facial aesthetics.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Hipertrofia/diagnóstico , Músculo Masseter/anormalidades , Fármacos Neuromusculares/uso terapêutico , Feminino , Humanos , Músculo Masseter/efeitos dos fármacos , Adulto Jovem
12.
Neurol Clin ; 39(1): 209-229, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33223084

RESUMO

Botulinum neurotoxin (BoNT) is an effective treatment for many neurologic disorders. This article gives a comprehensive overview of the clinical applications of BoNT across the field of neurology.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Doenças do Sistema Nervoso/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Humanos , Neurologia/métodos , Resultado do Tratamento
15.
Dermatol Surg ; 47(1): e5-e9, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33347002

RESUMO

BACKGROUND: A wide lower face and a square jaw are considered esthetic problems, particularly in Asia. OBJECTIVE: To investigate the optimal dose of a novel botulinum toxin (prabotulinum toxin A) for treating masseteric hypertrophy. METHODS: Ninety subjects with masseteric hypertrophy were randomly divided into 5 groups and treated with placebo (A, normal saline) or prabotulinum toxin A (B: 24, C: 48, D: 72, and E: 96 units). Photography, ultrasonography, and 3-dimensional imaging were performed before and after injection at baseline and at 4, 8, 12, and 16 weeks after treatment. The participants also rated their satisfaction. RESULTS: Masseter thickness significantly reduced in all groups at 12 weeks, compared with that in the placebo group. A dose-dependent reduction in masseter thickness was observed at the resting and maximal clenching positions. Sonography and 3-dimensional imaging revealed a gradual reduction in masseter thickness and volume, respectively, during the first 12 weeks. Despite being slightly effective, a dose of 24 units might be insufficient for resolving square face problems. Patients in Group E reported discomfort during jaw movement. CONCLUSION: Prabotulinum toxin A could effectively improve lower face contour without major complications, with an optimal dose of 48 to 72 units, followed by reinjection after 12 weeks.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Hipertrofia/tratamento farmacológico , Músculo Masseter/anormalidades , Fármacos Neuromusculares/uso terapêutico , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Relação Dose-Resposta a Droga , Método Duplo-Cego , Estética , Feminino , Humanos , Hipertrofia/diagnóstico por imagem , Injeções Intramusculares , Masculino , Músculo Masseter/diagnóstico por imagem , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Satisfação do Paciente , República da Coreia
16.
Int J Mol Sci ; 21(24)2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33322848

RESUMO

Botulinum toxins are neurotoxins produced by Clostridium botulinum. This toxin can be lethal for humans as a cause of botulism; however, in small doses, the same toxin is used to treat different conditions. Even if the therapeutic doses are effective and safe, the adverse reactions could be local and could unmask a subclinical impairment of neuromuscular transmissions. There are not many cases of adverse events in the literature; however, it is possible that sometimes they do not occur as they are transient and, if they do occur, there is no possibility of a cure other than to wait for the pharmacological effect to end. Inhibition of botulinum neurotoxin type A (BoNT/A) effects is a strategy for treating botulism as it can provide an effective post-exposure remedy. In this paper, 13,592,287 compounds were screened through a pharmacophore filter, a 3D-QSAR model, and a virtual screening; then, the compounds with the best affinity were selected. Molecular dynamics simulation studies on the first four compounds predicted to be the most active were conducted to verify that the poses foreseen by the docking were stable. This approach allowed us to identify compounds with a calculated inhibitory activity in the range of 316-500 nM.


Assuntos
Toxinas Botulínicas Tipo A/antagonistas & inibidores , Toxinas Botulínicas Tipo A/química , Simulação de Dinâmica Molecular , Relação Quantitativa Estrutura-Atividade , Bibliotecas de Moléculas Pequenas/farmacocinética , Toxinas Botulínicas Tipo A/efeitos adversos , Toxinas Botulínicas Tipo A/uso terapêutico , Clostridium botulinum/química , Bases de Dados Factuais , Ligação de Hidrogênio , Modelos Químicos , Modelos Moleculares , Bibliotecas de Moléculas Pequenas/química , Bibliotecas de Moléculas Pequenas/farmacologia , Bibliotecas de Moléculas Pequenas/toxicidade , Eletricidade Estática
18.
Toxicon ; 188: 48-54, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33045238

RESUMO

Our objective was to systematically review literature regarding the rationale and current evidence for peri-operative Botulinum Neurotoxin (BoNT) injection to improve outcomes of surgeries on spastic limbs. We conducted a systematic search of databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled until March 2020, using the PRISMA guidelines. After assessing all titles and abstracts against inclusion criteria, full texts were reviewed for studies of potential interest. The inclusion criteria were studies on humans with any study design, published in all languages. Participants had to have underlying limb spasticity and be scheduled to undergo surgery on one or more spastic limb(s). BoNT had to be administered peri-operatively to improve surgical outcomes and not solely for the purpose of alleviating spasticity. The risk of bias was evaluated using the Physiotherapy Evidence Database (PEDro) scoring system for randomized controlled trials (RCTs) and the Downs and Black tool for RCTs and non-randomized trials. Further, the level of evidence was evaluated using a five-level scale (simplified form of Sackett). Five studies met our inclusion criteria comprising a total of 90 participants, of both pediatric and adult age groups, with underlying limb spasticity, who received BoNT perioperatively to improve outcomes of the surgeries performed on spastic limbs. Interventions were intramuscular BoNT injection prior to, at the time of, or after surgery on a spastic limb for the purpose of improving surgical outcomes, and not solely for alleviating muscle spasticity. Outcome measures were surgical success/failure, post-operative pain and analgesic use, sleep quality, adverse events, spasticity control e.g. Modified Ashworth Scale. Our literature search yielded 5 articles that met the inclusion criteria. Current evidence supports peri-operative injection of BoNT to improve outcomes of surgeries performed on spastic limbs. There is level 1 evidence that BoNT administered pre-operatively is effective for reducing pain, spasticity, and analgesic use in pediatric patients with cerebral palsy (CP). This is supported by level 4 evidence from a retrospective case series. Level 5 evidence from case reports highlights the potential for the use of BONT in the peri-operative period. There is level 1 evidence that BoNT administered intra-operatively is not effective for reducing pain and analgesic use in pediatric patients with CP. This lack of benefit may reflect sub-optimal timing of injections, different methods of injection, different timing of the primary outcome measure, and/or differences in adjunctive therapies, but further research is required.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Espasticidade Muscular/cirurgia , Toxinas Botulínicas Tipo A/administração & dosagem , Paralisia Cerebral/tratamento farmacológico , Humanos , Injeções Intramusculares , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico
19.
J Headache Pain ; 21(1): 128, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33121445

RESUMO

BACKGROUND: The Covid-19 pandemic is causing changes in delivery of medical care worldwide. It is not known how the management of headache patients was affected by the lockdown during the pandemic. The aim of the present study was to investigate how the initial phase of the Covid-19 pandemic affected the hospital management of headache in Denmark and Norway. METHODS: All neurological departments in Denmark (n = 14) and Norway (n = 18) were invited to a questionnaire survey. The study focused on the lockdown and all questions were answered in regard to the period between March 12th and April 15th, 2020. RESULTS: The responder rate was 91% (29/32). Of the neurological departments 86% changed their headache practice during the lockdown. The most common change was a shift to more telephone consultations (86%). Video consultations were offered by 45%. The number of new headache referrals decreased. Only 36% administered botulinum toxin A treatment according to usual schemes. Sixty% reported that fewer patients were admitted for in-hospital emergency diagnostics and treatment. Among departments conducting headache research 57% had to halt ongoing projects. Overall, 54% reported that the standard of care was worse for headache patients during the pandemic. CONCLUSION: Hospital-based headache care and research was impacted in Denmark and Norway during the initial phase of the Covid-19-pandemic.


Assuntos
Infecções por Coronavirus , Assistência à Saúde , Transtornos da Cefaleia/terapia , Neurologia , Pandemias , Pneumonia Viral , Telemedicina/estatística & dados numéricos , Betacoronavirus , Toxinas Botulínicas Tipo A/uso terapêutico , Cefaleia Histamínica/diagnóstico , Cefaleia Histamínica/terapia , Dinamarca , Gerenciamento Clínico , Cefaleia/diagnóstico , Cefaleia/terapia , Transtornos da Cefaleia/diagnóstico , Departamentos Hospitalares , Hospitalização/estatística & dados numéricos , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/terapia , Fármacos Neuromusculares/uso terapêutico , Noruega , Ambulatório Hospitalar , Encaminhamento e Consulta , Inquéritos e Questionários , Telecomunicações/estatística & dados numéricos , Comunicação por Videoconferência/estatística & dados numéricos
20.
J Rehabil Med ; 52(10): jrm00110, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-32939558

RESUMO

OBJECTIVE: To investigate changes in hemiparetic gait parameters after treatment of elbow flexor spasticity with botulinum neurotoxin (BoNT) injection and adjunctive casting. DESIGN: Prospective case series. SUBJECTS: Ten participants with spasticity secondary to acquired brain injury (8 stroke, 2 traumatic brain injury). INTERVENTIONS: Participants received BoNT injections for their spastic elbow flexors under ultrasound guid-ance. Two weeks post-injection, an elbow stretching cast was applied for 1 week. OUTCOME MEASURES: Assessments using the Modified Ashworth Scale (MAS), Tardieu scale V1 angle of arrest at slow speed and V3 angle of catch at fast speed, 2-min walk test (2MWT), Edinburgh Gait Score scale (EGS) and video gait analysis for step-length symmetry were conducted pre-BoNT injection (t0) and at cast removal (t1). Goal attainment scale (GAS) was used to assess changes in spasticity and gait 3 months post-injection (t2). RESULTS: At t1, participants showed a mean increase of 16.7° (p < 0.01) on the Tardieu Scale V3 and a mean reduction of 0.5 points on the MAS (p < 0.05). There was also a mean reduction on EGS of 2.7 points (p < 0.05), and a mean increase on 2MWT of 3.1 m (p < 0.05). On the GAS, all participants report-ed impro-ved gait at t2 and 80% reported a decrease in spasticity. CONCLUSION: Combining BoNT injection with casting for treatment of elbow flexor spasticity without treat-ing the lower limb may improve hemiparetic gait parameters.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Cotovelo/patologia , Marcha/fisiologia , Espasticidade Muscular/terapia , Fármacos Neuromusculares/uso terapêutico , Paresia/tratamento farmacológico , Adulto , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Estudos Prospectivos
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