Early Botulinum Toxin Type A Injection for Post-Stroke Spasticity: A Longitudinal Cohort Study

Alessandro Picelli, Andrea Santamato, Michela Cosma, Alessio Baricich, Carmelo Chisari, Marzia Millevolte, Cristina Del Prete, Ilenia Mazzù, Paolo Girardi, Nicola Smania, Alessandro Picelli, Andrea Santamato, Michela Cosma, Alessio Baricich, Carmelo Chisari, Marzia Millevolte, Cristina Del Prete, Ilenia Mazzù, Paolo Girardi, Nicola Smania

Abstract

Early management of spasticity may improve stroke outcome. Botulinum toxin type A (BoNT-A) is recommended treatment for post-stroke spasticity (PSS). However, it is usually administered in the chronic phase of stroke. Our aim was to determine whether the length of time between stroke onset and initial BoNT-A injection has an effect on outcomes after PSS treatment. This multicenter, longitudinal, cohort study included stroke patients (time since onset <12 months) with PSS who received BoNT-A for the first time according to routine practice. The main outcome was the modified Ashworth scale (MAS). Patients were evaluated before BoNT-A injection and then at 4, 12, and 24 weeks of follow-up. Eighty-three patients with PSS were enrolled. MAS showed a significant decrease in PSS at 4 and 12 weeks but not at 24 weeks after treatment. Among the patients with a time between stroke onset and BoNT-A injection >90 days, the MAS were higher at 4 and 12 weeks than at 24 weeks compared to those injected ≤90 days since stroke. Our findings suggest that BoNT-A treatment for PSS should be initiated within 3 months after stroke onset in order to obtain a greater reduction in muscle tone at 1 and 3 months afterwards.

Keywords: botulinum toxins; muscle spasticity; rehabilitation; stroke; therapeutics.

Conflict of interest statement

The authors declare that they have no conflict of interest related to this study and the publication of this manuscript.

Figures

Figure 1
Figure 1
Frequency distribution of MAS and MRS by follow-up time.
Figure 2
Figure 2
Distribution of MI values by follow-up time and site. p-Value resulting from the Kendall correlation test between MI and weeks was reported by site.

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