scholarly journals Botulinum Toxin Type A and Physiotherapy in Spasticity of the Lower Limbs Due to Amyotrophic Lateral Sclerosis

Toxins ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 381 ◽  
Author(s):  
Riccardo Marvulli ◽  
Marisa Megna ◽  
Aurora Citraro ◽  
Ester Vacca ◽  
Marina Napolitano ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Rating Scale ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Lower Limbs ◽  
Number Of Patients ◽  
Modified Ashworth Scale ◽  
Ashworth Scale ◽  
Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease (unknown pathogenesis) of the central nervous system that causes death within 1–5 years. Clinically, flabby paralysis, areflexia, muscular atrophy, and muscle fasciculations, signs of II motor neuron damage, appear. Sometimes, clinical manifestations of damage of the I motor neuron come out in lower limbs; spastic paralysis, iperflexia, and clonus emerge, and they impair deambulation and management of activities of daily living, such as personal hygiene or dressing. Thus, the first therapeutic approach in these patients involves antispasmodic drugs orally followed by botulinum toxin type A injection (BTX-A). In this study, we study the efficacy of BTX-A and physiotherapy in lower limb spasticity due to ALS and no response to treatment with oral antispastic drugs. We evaluated 15 patients (10 male and five female), with a mean age of 48.06 ± 5.2 with spasticity of adductor magnus (AM), at baseline (T0, before BTX-A treatment) and in the following three follow-up visits (T1 30 days, T2 60 days, and T3 90 days after infiltration). We evaluated myometric measure of muscle tone, the Modified Ashworth Scale of AM, Barthel Index, Adductor Tone Rating Scale, and Hygiene Score. The study was conducted between November 2018 and April 2019. We treated AM with incobotulinum toxin type A (Xeomin®, Merz). Spasticity (myometric measurement, Adductor Tone Rating Scale, and Modified Ashworth Scale) and clinical (Barthel Index and Hygiene Score) improvements were obtained for 90 days after injection (p < 0.05). Our study shows the possibility of using BTX-A in the treatment of spasticity in patients with ALS and no response to oral antispastic drugs, with no side effects. The limitation of the study is the small number of patients and the limited time of observation; therefore, it is important to increase both the number of patients and the observation time in future studies.

Botulinum toxin type A for the treatment of sialorrhoea in amyotrophic lateral sclerosis: A clinical and neurophysiological study

2009 ◽  
Vol 11 (4) ◽  
pp. 359-363 ◽  
Author(s):  
Francesca Gilio ◽  
Elisa Iacovelli ◽  
Vittorio Frasca ◽  
Maria Gabriele ◽  
Elena Giacomelli ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Botulinum Toxin ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Neurophysiological Study ◽  
Lateral Sclerosis

Botulinum toxin type A therapy in a patient with cervical dystonia and amyotrophic lateral sclerosis

2007 ◽  
Vol 22 (2) ◽  
pp. 289-289 ◽  
Author(s):  
Carlos Singer ◽  
Spiridon Papapetropaulos ◽  
D. Ram Ayyar ◽  
Ashok Verma
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Botulinum Toxin ◽  
Cervical Dystonia ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Lateral Sclerosis

scholarly journals Botulinum Toxin Type A Injections as Monotherapy for Upper Limb Essential Tremor Using Kinematics

2017 ◽  
Vol 45 (1) ◽  
pp. 11-22 ◽  
Author(s):  
Olivia Samotus ◽  
Niraj Kumar ◽  
Philippe Rizek ◽  
Mandar Jog
Keyword(s):  
Botulinum Toxin ◽  
Essential Tremor ◽  
Upper Limb ◽  
Rating Scale ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Functional Improvement ◽  
Motion Sensors ◽  
Dosing Patterns

AbstractBackground:There is a significant need for a targeted therapy for essential tremor (ET), as medications have not been developed specifically for ET, and the ones prescribed are often not well-tolerated, so that many patients remain untreated. Recent work has shown that, unlike previous experience, kinematically guided individualized botulinum toxin type A (BoNT-A) injections provide benefit along with minimal weakness. Ours is the first long-term (96-week) safety and efficacy study of BoNT-A as monotherapy for ET using kinematically driven injection parameters.Methods:Ten ET patients were administered six serial BoNT-A treatments every 16 weeks and were assessed at 6 weeks following treatment. During each study visit, the Fahn–Tolosa–Marin (FTM) scale, the Unified Parkinson’s Disease Rating Scale, and the Quality of Life for Essential Tremor Questionnaire (QUEST) were administered along with kinematic assessment of the treated limb. Participants performed scripted tasks with motion sensors placed over each arm joint. Dosing patterns were determined using the movement disorder neurologist’s interpretation of muscles contributing to the kinematically analyzed upper limb tremor biomechanics.Results:There was a 33.8% (p<0.05) functional improvement (FTM part C) and a 39.8% (p<0.0005) improvement in QUEST score at week 96 compared to pretreatment scores at week 0. Although there was a 44.6% (p<0.0005) non-dose-dependent reduction in maximal grip strength, only 2 participants complained of mild weakness. Following the fourth serial treatment, mean action tremor score was reduced by 62.9% (p=0.001) in the treated and by 44.4% (p=0.03) in the untreated arm at week 96 compared to week 48.Conclusions:Individualized BoNT-A dosing patterns to each individual’s tremor biomechanics provided an effective monotherapy for ET as function improved without functionally limiting muscle weakness.

Serial Casting as an Adjunct to Botulinum Toxin Type A Treatment in Children With Cerebral Palsy and Spastic Paraparesis With Scissoring of the Lower Extremities

2017 ◽  
Vol 32 (7) ◽  
pp. 671-675 ◽  
Author(s):  
Alper I. Dai ◽  
Abdullah T. Demiryürek
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin ◽  
Botulinum Toxin Type A ◽  
Spastic Paraparesis ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Caregiver Health ◽  
Serial Casting ◽  
Modified Ashworth Scale ◽  
Children With Cerebral Palsy

The purpose of this study was to examine whether combination therapy of serial casting and botulinum toxin type A injection can further enhance the effects of botulinum toxin type A in children with cerebral palsy with scissoring of both legs. This study was a prospective and randomized trial. The children were divided into 2 groups, one of which received serial casting after botulinum toxin type A (n = 40), and the other which only received botulinum toxin type A (n = 40). Serial casting started 3 weeks after the botulinum toxin type A. Both groups received physiotherapy. Groups were assessed at baseline then compared at 6 and 12 weeks following the intervention. Significant improvements in Gross Motor Function Measure–66 and Caregiver Health Questionnaire were recorded in both groups ( P < .001). The modified Ashworth scale improved significantly following botulinum toxin type A in the serial casting group ( P < .05), but not in botulinum toxin type A only group. These results suggest that serial casting after botulinum toxin type A can enhance the benefits of botulinum toxin type A in children with cerebral palsy.

scholarly journals Botulinum Toxin Type a for Rehabilitation after a Spinal Cord Injury: A Case Report

2009 ◽  
Vol 17 (1) ◽  
pp. 96-99 ◽  
Author(s):  
AS Naicker ◽  
SA Roohi ◽  
JLL Chan
Keyword(s):  
Botulinum Toxin ◽  
Weight Bearing ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Well Being ◽  
Botulinum Toxin Type ◽  
Pressure Sore ◽  
Lower Limbs ◽  
Severe Spasticity ◽  
Cord Injury

A 56-year-old man became quadriplegic, bed bound, and carer-dependent secondary to cervical osteomyelitis. Three years later, he presented with generalised spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his hips and knees prevented ischial sitting. Injections of botulinum toxin type A to both hamstrings and gastrosoleuii controlled the flexor spasticity of his lower limbs and facilitated rehabilitation and wound healing through proper positioning, wound care, stretching, and weight-bearing exercises. A few weeks later, the patient could better position himself in bed (prone lying) and on his wheelchair (ischial sitting). His spasm-related pain lessened and his mobility and activities of daily living improved. The sacral pressure sore healed completely a few months later. The patient could sleep better, feed with set-up and adaptive aids, groom, dress, and transfer himself with minimal assistance. The effects of botulinum toxin extended beyond just spasticity reduction. His upper extremity function, mobility, and social well-being were all improved through better positioning.

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