Article

OBJECTIVE: To determine if botulinum toxin type A injection at the proximal 2/10
and 3/10 of calf length, where the intramuscular nerve endings of the
gastrocnemius muscle are densely distributed, is more efficacious in controlling
plantarflexion spasticity than injection at distant sites within the same muscle.
DESIGN: A double-blind randomized controlled trial. SETTTING: Two rehabilitation
centres. SUBJECTS: Forty stroke patients were randomly allocated to two groups.
Group A received injection at the proximal 2/10 and 3/10 of calf length, group B
at and below the midbelly of the muscle. Both groups received 200 IU of botulinum
toxin A and were followed up to eight weeks. MAIN MEASURES: Primary variables
were the surface electromyography values recorded during plantarflexion;
secondary variables were the Modified Ashworth Scale, Modified Tardieu Scale,
clonus scale, 10-metre walking test, ABILOCO and Functional Ambulation
Categories. RESULTS: At baseline, the median Modified Ashworth Scale was 2.0
(range,1+ -3.0), and there were no significant differences between the two groups
in all the parameters, including spasticity. Compared to baseline, no significant
differences between the two groups were detected in all the surface
electromyography and clinical parameters at week 8 (P > 0.05). Both groups showed
significant improvement of spasticity with a median Modified Ashworth Scale of 1+
(range, 0.0-2.0) at eight weeks. CONCLUSIONS: Botulinum toxin A injection was
associated with a significant improvement from baseline to week 8 in both
treatment groups, however, no significant difference between the 2 groups was
observed, based on the electrophysiological and clinical parameters employed in
this study.
CI - (c) The Author(s) 2014.

Langue : ANGLAIS