Japanese

Clinical Efficacy of a Double Injection Protocol of Botulinum Toxin Type A for Upper Limb Hemiparesis after Stroke Toru Takekawa 1 , Takatoshi Hara 1 , Wataru Kakuda 1 , Kazushige Kobayashi 1 , Yousuke Sase 2 , Masahiro Abo 1 1Department of Rehabilitation Medicine, The Jikei University School of Medicine 2Department of Rehabilitation Medicine, The Jikei University School of Medicine Keyword: 脳卒中(stroke) , 痙縮(spasticity) , 運動障害(motor impairment) , ボツリヌス毒素(botulinum toxin) , リハビリテーション(rehabilitation) pp.38-46
Published Date 2014/1/18
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Abstract Background : The aim of this study was to assess the effects of repeated injections of botulinum toxin type A (BoNT-A) combined with a rehabilitative program for treating spastic upper limb hemiparesis after stroke. Subjects and methods : Subjects were 112 poststroke hemiparetic patients with spastic upper limb (mean age : 55.5±11.6 years ±SD, mean period between onset and first injection : 5.1±3.5 years). For each patient, BoNT-A (maximum dose of each injection : 240 units) was injected in the spastic muscles of the affected upper limb twice with a minimum interval of 3 months. Following each injection, detailed one-to-one instructions for home-based functional training was provided. At the baseline (before injection) and at 1 and 3 month follow-ups after each injection, the patient's modified Ashworth scale (MAS), the range of motion (ROM) and Fugl-Meyer Assessment (FMA) were evaluated. Results : The total score for the upper limb and the scores of categories A and B of the FMA increased significantly not only after the first injection but after the second injection compared with the second baseline, while the FMA score for category D increased significantly only after the second injection. MAS also decreased significantly not only after the first injection but after the second injection compared to the second baseline. Conclusion : A more significant improvement was found not only in muscle spasticity but also in upper limb motor function after two BoNT-A injections. It is suggested that repeated BoNT-A injections followed by a comprehensive rehabilitative program would be an effective treatment for limb spasticity after a stroke.


Copyright © 2014, The Japanese Association of Rehabilitation Medicine. All rights reserved.

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電子版ISSN 印刷版ISSN 1881-3526 日本リハビリテーション医学会

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