Article

Botulinum neurotoxin type A (BoNT-A) reduces upper-extremity
poststroke spasticity when given 6 or more months after stroke. Effects on
functional use of the arm and hand are less apparent. OBJECTIVE: To determine the
effect and safety of very early use of BoNT-A for patients with upper-limb
spasticity. METHODS: The Asia Botulinum Toxin-A Clinical Trial DESIGN: ed for
Early Post-stroke Spasticity (ABCDE-S; NCT00234546) was a multicenter,
randomized, placebo-controlled trial conducted in patients recruited within 2 -12
weeks of first-ever stroke. Participants with a Modified Ashworth Scale (MAS)
score of 1+ or above received BoNT-A (Dysport) 500 U or placebo to one or more
wrist and elbow mover muscles, plus unstructured rehabilitation. The primary
outcome was the MAS score in the most affected joint 4 weeks after first
injection. Follow-up was 24 weeks. RESULTS: A total of 163 patients were enrolled
and assigned to placebo (n = 83) or BoNT-A (n = 80). Mean time since stroke was
about 7 weeks. At 4 weeks postinjection, BoNT-A significantly improved MAS
scores. Treatment effect-size estimates increased with higher baseline MAS scores
from 0.45 (Q1) to 0.70 (Q3). MAS scores for all secondary end points improved
with BoNT-A versus placebo at all time points (P < .0001, all visits). The
Functional Motor Assessment Scale did not reveal clinically significant
differences. No group differences in adverse events were found. Interpretation.
BoNT-A 500 U can provide a sustained reduction in poststroke upper-limb
spasticity when combined with rehabilitation in Asian patients who have
mild-to-moderate hypertonicity and voluntary movement, within 2 -12 weeks of
stroke. Functional use of the arm and hand was not affected.

Langue : ANGLAIS