P-2-13-02
THE EFFECT OF DIFFERENT REGIMENS OF BOTULINUM TOXIN INJECTIONS IN UPPER LIMB SPASTICITY
N. Renklitepe, Z. Guven, N. 0zaras, 0. Kayhan
Marmara University Medical Faculty, Dept. of PM&R, Istanbul/TURKEY
The purpose of this study was to investigate the effectiveness of different regimens of botulinum toxin-A injections in upper limb flexor spasticity due to stroke. Twenty patients (6 female/14 male) divided into two equal group of ten, with upper limb spasticity (at least grade 3 according to Ashworth Scale) were included into the study. The mean age of the patients was 59±8.6 and mean interval since stroke onset was 19.2± 8.3 months. The first group and second groups were injected under EMG guidance, 12.5 ngr toxin and 40 ngr of botulinum toxin A respectively. Modified Ashworth Spasticity Scale, Motricity Index, Modified Barthel Scale and goniometric measurements were performed as assessment criteria.
The patients were examined prior to injection and 2 weeks, I month, 2 months and 3 months later. Statically significant reduction in M. Ashworth Scale scores were found m both groups (p<0.05). The clinical effect lasted up to the end of the 3rd month. Self care abilities including washing hands, cutting fingernails and dressing were faciliated. However any gain in selective movements (Motricty Index) or in independence (M. Bathel Index) were not achieved.
In conclusion, botulinum toxin-A injection is a safe, locally effective and well tolerated method in spastic disorders resistant to conventional therapy methods.
P-2-13-03
THE EFFECT OF SHORT-TERM ELECTICAL STIMULATION AFTER BOTULINUM TOXIN INJECTION IN THE TREATMENT OF UPPER LIMB SPASTICITY
N. Renklitepe, N.Ozaras: Z. Guven, 0.Kayhan.
Marmara Umversity Medical Faculty, Dept. of PM&R, Istanbul, Turkey
The aim of this study was to evaluate the effectiveness of electrical stimulation after the Botulininum toxin injection in chronic hemiparetic patients with upper limb spasticky due to stroke. Eight patients were randomly divided into two groups. In the first group four patients were injected with a total of 100 IU Botulinum toxin A (Botox) into the flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis and profundus muscles.
The second group of four patients received the same amount of the toxion in the same muscles previously to an additional repetitive alternating electrical stimulation to injected muscles and extansor digitorum communis, extansor carpi radialis longus and brevis muscles for 30 min. two times per day during the 3 consecutive days. Both groups were assessed at baseline and at the end of four weeks. According to Modified Ashworth Spasticity Scale, spasticity reduction at least of one point with increased range of motion was observed in all patients. Additionally statistically significant improvement in the Motricity Index and M. Barthel Index was found in the second group (p</0.05).
In conclusion, electrical stimulation just after the Botulinum toxin injection enhancing toxin uptake and accelerating onset of its paralytic effect, showed to be more effective than toxin injection alone in the treatment of spasticity in chronic hemiparetic patients.
