Effect of botulinum toxin type-A in patients with focal spasticity

OBJECTIVE: To investigate the effect of botulinum toxin type-A (BTX-A) on spasticity and function in patients with focal spasticity.
METHODS: Patients attended to the outpatient clinic of physical medicine and rehabilitation department with a diagnosis of focal spasticity and had BTX-A injections because of spasticty were evaluated for the study. Demographic data, exercise status, orthoses, drugs used for spasticity, functional status, stages of spasticity of muscles before and after 1st and 3rd months of BTX-A injection according to Modified Ashworth Scale (MAS) were evaluated retrospectively. MedCalc 11.6 statistical program was used for statistical analyses. Statistical significance was defined as p<0.05.
RESULTS: Forty-nine patients with focal spasticity were recruited for the study (35 men, 14 women). Mean age of the patients was 21.59±20.09 years. The patients had cerebral palsy (CP, n=28), 19 had hemiplegia (n=19) and paraplegia (n=2). Forty-three patients were using orthoses and exercising regularly. Mean Pediatric Functional Independence Measurement (WeeFIM) scores of the patients with CP was 54.82±28.91 and according to the Gross Motor Function Classification System (GMFCS) the patients were in stages 2 (14%), 3 (46%), 4 (11%) and 5 (29%). Mean Functional Independence Measure (FIM) of hemiplegic and paraplegic patients was 80.80±20.88. Brunnstrom staging scores for upper extremity (3.52±0.96), hands (2.68±0.82), lower extremity (4.57±1.01) were calculated. MAS muscles demonstrated statistically significant decrease in spasticity at the end of first and third months (p<0.05).
CONCLUSION: We saw a significant decrease in the spasticity of upper and lower extremities in patients with
focal spasiticity who received BTX-A injections. We suggest that if BTX-A injections are supported with orthoses and exercise programs, then functional status of the patients would be better.

Fokal spastisiteli hastalarda botulinum toksin tip-A’ nýn etkinliði

AMAÇ: AMAÇ: Bu fokal spastisiteli hastalarda Botulinum toxin tip-A’nýn (BTX-A) spastisite ve fonksiyon üzerine etkinliðinin araþtýrýlmasý amacýyla planlandý
YÖNTEMLER: Fizik tedavi ve rehabilitasyon kliniðine baþvuran fokal spastisite tespit edilmiþ ve spastisite nedeniyle BTX-A enjeksiyonu yapýlmýþ olan hastalar retrospektif olarak deðerlendirildi. Vakalarýn demografik bilgileri, egzersiz durumlarý, kullanýlan ortezler, ilaçlar ve fonksiyonel durumlarý kaydedildi BTX-A enjeksiyonu uygulanmýþ olan kas gruplarýnýn tedavi öncesi ve 1. ve 3. ay sonrasý Modifiye Ashworth Skalasýna (MAS) göre spastisite dereceleri deðerlendildi. Ýstatistiksel analizler için MedCalc 11.6 kullanýldý. p<0.05 deðeri istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Çalýþmaya fokal spastisiteli 49 hasta dahil edildi (35 erkek, 14 kadýn). Hastalarýn yaþ ortalamasý 21.59 ± 20.09 yýldý. Hastalarýn tanýlarý serebral palsi (CP) (n: 28), hemipleji (n: 19) ve parapleji (n: 2) idi. Kýrküç hasta ortez kullanýyor ve düzenli egzersiz yapýyordu. CP’ li hastalarýn Pediatrik Fonksiyonel Baðýmsýzlýk Ölçeði (WeeFIM) ortalamasý 54.82 ± 28.91 idi. Kaba Motor Fonksiyonel Sýnýflandýrma Sistemine (GMFCS) göre, CP’li hastalarýn %14’ü seviye 2, %46’sý seviye 3, %11’i seviye 4, %29’u seviye 5 idi. Hemipleji ve paraplejili hastalarýn Fonksiyonel Baðýmsýzlýk Ölçeði skoru ortalama 80.80 ± 20.88 idi. Hemiplejili hastalarýn Brunnstrom evrelemesi ortalamasý üst ekstremitede 3.52 ± 0.96, elde 2.68 ± 0.82, alt ekstremitede 4.57 ± 1.01 idi. BTX-A enjeksiyonu yapýlan hastalarýn spastisitelerinde MAS ölçümleriyle, baþlangýca kýyasla 1. ve 3. ayda istatistiksel olarak anlamlý azalma saptandý (p<0.05).
SONUÇ: BTX-A enjeksiyonu ile, fokal spastisiteli hastalarýn üst ve alt ekstremite spastisitesinde belirgin azalma görüldü. Hastalarýn fonksiyonel durumlarýnýn, ortez kullanýmý ve egzersizle desteklendiðinde daha iyi olabileceðini düþünmekteyiz.