- •Retrospective chart review on first BoNT injections within 15 months post-stroke.
- •About one-third of these patients received BoNT injections within 3 months.
- •Higher BoNT doses and longer inter-injection intervals for those received injections early.
Our primary objective was to compare early-start vs. late-start Botulinum toxin (BoNT) injections in post-stroke spasticity management. This is an IRB approved retrospective chart review of patients who were admitted for inpatient rehabilitation within 6 months after first-ever stroke between January 2014 and December 2018 and received BoNT injections within 15 months. The total dose and interval between consecutive injections were used as objective outcomes. 2367 stroke admissions were reviewed. 189 patients metinclusion criteria. 68 out of 189 patients received BoNT injections within 12 weeks after stroke (EARLY group). 20 patients in the EARLY group who received at least three cycles were included for analysis. Out of 189 patients, 47 patients were categorized into the Early- and Late-start subgroups each by time from stroke onset to first BoNT injection (1st and 4th quartiles of time distribution) for comparisons. In the EARLY group, the first interval (Mean (M) = 7.6 weeks, standard deviation (SD) = 2.14) was significantly shorter than the second interval (M = 23.7, SD = 10.41) and the third interval (M = 20.0, SD = 11.23; p < 0.05). The dose at the first cycle (M = 492 units, SD = 201.5) was significantly lower than the dose at the third cycle (M = 605, SD = 82.6). In comparison between the Early- and Late-start subgroups, the time to first BoNT injection was 6.4 weeks (range: 4.7–8.6) after stroke for the Early-start subgroup and 49.6 weeks (range: 27.4–62.3) after stroke for the Late-start subgroup. The subsequent intervals after the first injection were significantly longer in the Early-start subgroup (M = 23.1 weeks) than in the Late-start subgroup (M = 14.6 weeks) (p = 0.008). The average total dose of BoNT was significantly higher in the Early-start subgroup (M = 561.9 units, SD = 143.1) than the Late-start subgroup (M = 470.0, SD = 164.8) (p = 0.012). The findings showed that higher doses of BoNT were used in the Early-start group, and often resulted in longer intervals between subsequent injections than in the Late-start group.
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- Spasticity, motor recovery, and neural plasticity after stroke.Front. Neurol. 2017; 8: 120
- New insights into the pathophysiology of post-stroke spasticity.Front. Hum. Neurosci. 2015; 9: 192
- A unifying pathophysiological account for post-stroke spasticity and disordered motor control.Front. Neurol. 2019; 10: 468
- Can the early use of botulinum toxin in post stroke spasticity reduce contracture development? A randomised controlled trial.Clin. Rehabil. 2020; https://doi.org/10.1177/0269215520963855
- When does spasticity in the upper limb develop after a first stroke? A nationwide observational study on 861 stroke patients.J. Clin. Neurosci. 2019; 66: 144-148
- Onset, time course and prediction of spasticity after stroke or traumatic brain injury.Ann. Phys. Rehabil. Med. 2019; 62: 431-434
- Spasticity after stroke: its occurrence and association with motor impairments and activity limitations.Stroke. 2004; 35: 134-139
- Prevalence and evolution of spasticity in patients suffering from first-ever stroke with carotid origin: a prospective, longitudinal study.Eur. J. Neurol. 2019; 26: 880-886
- Association of spasticity and motor dysfunction in chronic stroke.Ann. Phys. Rehabil. Med. 2018; 62: 397-402
- Pathophysiology of spastic paresis. II: Emergence of muscle overactivity.Muscle Nerve. 2005; 31: 552-571
- Pathophysiology of spastic paresis. I: Paresis and soft tissue changes.Muscle Nerve. 2005; 31: 535-551
- Post-stroke hemiplegic gait: new perspective and insights.Front. Physiol. 2018; 9: 1021
- Ankle and foot spasticity patterns in chronic stroke survivors with abnormal gait.Toxins (Basel). 2020; 12: 646
- Poststroke spasticity management.Stroke. 2012; 43: 3132-3136
- Assessing and treating functional impairment in poststroke spasticity.Neurology. 2013; 80: S35-S44
- Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache report of the guideline development Subcommittee of the American Academy of neurology.Neurology. 2016; 86: 1818-1826
- European consensus table on the use of botulinum toxin type a in adult spasticity.J. Rehabil. Med. 2009; 41: 13-25
- Effectiveness of botulinum toxin treatment for upper limb spasticity after stroke over different ICF domains: a systematic review and meta-analysis.Arch. Phys. Med. Rehabil. 2019; 100: 1703-1725
- Botulinum toxin as early intervention for spasticity after stroke or non-progressive brain lesion: a meta-analysis.J. Neurol. Sci. 2016; 371: 6-14
- Does low-dose botulinum toxin help the recovery of arm function when given early after stroke? A phase II randomized controlled pilot study to estimate effect size.Clin. Rehabil. 2010; 24: 501-513
- An early botulinum toxin A treatment in subacute stroke patients may prevent a disabling finger flexor stiffness six months later: a randomized controlled trial.Clin. Rehabil. 2012; 26: 237-245
- Botulinum toxin injection for hypertonicity of the upper extremity within 12 weeks after stroke: a randomized controlled trial.Neurorehabil. Neural Repair. 2012; 26: 812-821
- Early botulinum toxin treatment for spastic pes equinovarus--a randomized double-blind placebo-controlled study.Eur. J. Neurol. 2014; 21: 1089-1095
- Gait improvement by low-dose botulinum toxin a injection treatment of the lower limbs in subacute stroke patients.J. Phys. Ther. Sci. 2015; 27: 759-762
- Early AbobotulinumtoxinA (Dysport((R))) in post-stroke adult upper limb spasticity: ONTIME pilot study.Toxins (Basel). 2018; 10: 253
- Effectiveness of abobotulinumtoxina in post-stroke upper limb spasticity in relation to timing of treatment.Front. Neurol. 2020; 11: 104
- Conversion ratio between botox®, dysport®, and xeomin® in clinical practice.Toxins. 2016; 8: 65
Published online: April 14, 2021
Accepted: April 12, 2021
Received in revised form: March 6, 2021
Received: January 11, 2021
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