Is Spastic Muscle Echo Intensity Related to the Response to Botulinum Toxin Type A in Patients With Stroke? A Cohort Study

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• 作者：Alessandro Picelli ; MD^a ; ^c ; Paola Bonetti ; MD^a ; Carla Fontana ; MD^a ; Martina Barausse ; MD^a ; Francesca Dambruoso ; MD^a ; Francesca Gajofatto ; MD^a ; Paolo Girardi ; MSc^b ; Mario Manca ; MD^d ; Raffaele Gimigliano ; MD^e ; Nicola Smania ; MD^a ; ^f ; ^{nicola.smania@univr.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Fibrosis ; Muscle ; skeletal ; Muscle spasticity ; Rehabilitation ; Ultrasonography
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2012
• 出版时间：July 2012
• 年：2012
• 卷：93
• 期：7
• 页码：1253-1258
• 全文大小：450 K

文摘

Picelli A, Bonetti P, Fontana C, Barausse M, Dambruoso F, Gajofatto F, Girardi P, Manca M, Gimigliano R, Smania N. Is spastic muscle echo intensity related to the response to botulinum toxin type A in patients with stroke? A cohort study.

Objective

To investigate the relationship between gastrocnemius muscle echo intensity and response to botulinum toxin type A (BoNT-A) in patients with spastic equinus foot resulting from stroke.

Design

Cohort study.

Setting

University hospital.

Participants

Adult patients (N=56) with spastic equinus foot resulting from stroke scheduled to receive BoNT-A injection into the gastrocnemius muscle.

Interventions

All patients were injected with BoNT-A (abobotulinumtoxinA) into the gastrocnemius muscle with an ultrasonography-guided, multisite injection technique. The toxin dose was 250U for the gastrocnemius medialis and 250U for the gastrocnemius lateralis (dilution 500U/2mL) in each patient. All patients were evaluated before and 4 weeks after BoNT-A injection.

Main Outcome Measures

Spastic gastrocnemius muscle echo intensity visually graded with the Heckmatt scale. Clinical assessment of the spastic gastrocnemius with the Modified Ashworth Scale, Tardieu Scale, and ankle passive range of motion.

Results

Postintervention testing at 4 weeks showed overall significant improvements in the clinical assessment of the spastic gastrocnemius muscle. No significant change was observed in the echo muscle intensity of the spastic gastrocnemius after BoNT-A injection. Post hoc comparisons showed that all clinical outcomes were significantly better in those patients with echo muscle intensity of the spastic gastrocnemius graded II on the Heckmatt scale than those with grades III (P<.001) and IV (P<.001) after botulinum toxin injection.

Conclusions

These findings support the hypothesis that patients with higher spastic muscle echo intensity have a reduced response to BoNT-A.