Article

OnabotulinumtoxinA reduces muscle hypertonia associated with
poststroke spasticity (PSS). PSS manifests as several common postures. OBJECTIVE:
To define treatment paradigms for PSS upper-limb common postures. DESIGN:
Modified Delphi method. SETTING: Expert panel. PARTICIPANTS: Ten injectors
experienced in the treatment and clinical research of PSS (physiatrists and
neurologists) were invited to participate in the Delphi panel. METHODS: The
Delphi panel reviewed an electronic worksheet with PSS upper-limb postures to
define onabotulinumtoxinA treatment paradigms (Round 1). During Round 2, panel
members discussed in person Round 1 results and voted until consensus (>/=66%
agreement). Recommendations were geared toward those with new or early injection
experience. MAIN OUTCOME MEASUREMENTS:
Expert consensus on onabotulinumtoxinA
treatment parameters for PSS including muscles to inject, dose per muscle and
posture, and treatment adjustments for suboptimal response. RESULTS: For each
posture, consensus was reached on targeted subsets of muscles. Doses ranged for
individual muscles (10-100 U) and total doses per posture (50-200 U). An
onabotulinumtoxinA dilution 50 U/mL (2:1 dilution ratio) was considered most
appropriate; dilution ratios of 1:1 to 4:1 may be appropriate in some
circumstances. The majority (89%) of panel members would increase the dose and/or
the number of muscles treated for a suboptimal response to onabotulinumtoxinA.
The panel identified 3 common aggregate upper-limb postures: (1) adducted
shoulder + flexed elbow + pronated forearm + flexed wrist + clenched fist; (2)
flexed elbow + pronated forearm + flexed wrist + clenched fist; and (3) flexed
wrist + clenched fist. The recommended starting dose per aggregate was 300 U, 300
U, and 200 U, with a total maximum dose of 400 U, 400 U, and 300 U, respectively.
Localization guidance techniques were considered essential for all postures.
CONCLUSIONS: Consensus on common muscles and onabotulinumtoxinA treatment
paradigms for postures associated with upper-limb PSS was achieved via a modified
Delphi method. The purpose of this analysis is to educate early
onabotulinumtoxinA injectors rather than provide an evidence-based review. LEVEL OF EVIDENCE: V.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS