Article

A few studies have reported the use of botulinum toxin injections
after spinal cord injury, as this is the gold standard to treat focal spasticity.
We report such a case here. CASE REPORT: A 38-year-old woman who had become
paraplegic and care-dependent secondary to cervico-thoracic intramedullary
ependymoma, presented 8 months later with painful lower limb spasticity, which
was being treated with oral anti-spastic and benzodiazepine drugs with no
therapeutic effect. We treated the patient with intrathecal baclofen to reduce
her spasticity and in order to avoid the major side-effects of high dosages of
oral baclofen. After motor rehabilitation programmes, which included functional
electrical stimulation, the patient was able to wear an advanced reciprocating
gait orthosis. However, she experienced painful muscle spasms in her toes of the
feet that limited her gait. Therefore, she was also treated with bilateral
injections of botulinum toxin type A into the flexor digitorum brevis muscles.
The patient reported relief of spasms and pain, enabling her to wear an advanced
reciprocating gait orthosis and facilitating rehabilitation programmes.
CONCLUSION: The use of botulinum toxin type A may be an important adjunctive
therapy to increase the therapeutic effect of baclofen on spasticity in small
muscles, resulting in a more focal effect, and improving the use of orthoses and
the effectiveness of rehabilitation programmes in patients after spinal cord
injury.

Langue : ANGLAIS