Botulinum Toxin Type-A (BoNT-A) treatment interventions in stroke, traumatic brain injury and adults with cerebral palsy related muscle overactivity: A six-year retrospective review Alberto Esquenazi, MD*; Nathaniel Mayer, MD*; Stella Kim, MPA* and Matteo Cioni, MD† Theera Vachranukunkiet, MD* *MossRehab Gait and Motor Control Analysis Laboratories, Philadelphia, PA; †Department of Experimental & Clinical Pharmacology University of Catania, Italy. Objective: To determine the patterns of Botulinum Toxin Type-A (BoNT-A) injection muscle selection, dosing and frequency of intervention associated with muscle overactivity in stroke, traumatic brain injury (TBI) and adult cerebral palsy (ACP) patients. Materials and Methods: Design: Retrospective review of data collected from 2003-2008. Setting: Gait & Motor Control Analysis Laboratories in a tertiary rehabilitation hospital. Participants: Data on 461 patients (1,430 sessions). Interventions: Clinically indicated BoNT-A injections for muscle overactivity. Main Outcome Measures: Patient demographics, limbs treated, muscle selection, treatment dose and frequency of treatment over time. Results: Data comprised of 461 patients (57.7% stroke, 27.5% TBI and 14.8% ACP). Average age at initial visit was 49 years (range, 18-89y). More than half of the patients were men (53.8%). Over forty percent of the patients had right side involvement, but for the stroke group 28.9% had left hemiparesis. There was no statistical significance between diagnosis and dose. However, the average number of muscles injected was less in ACP and in TBI patients compared to stoke patients. Average treatment dose for the lower limb was 300.0 122.4 and 288.7 149.0 units for the upper limb. Commonly treated patterns in the upper and lower limbs included: flexed wrist/fingers and the equinovarus foot. The flexor digitorum superficialis (FDS) was the most commonly injected muscle (26.5%) for the flexed wrist/fingers. The medial/lateral gastrocnemius muscles (40.3%) were the most frequently treated muscles for the equinovarus foot deformity. Treatment sessions ranged from 1 to 18 with an average of 3.1 treatment visits. Conclusions: This long term review in the management of BoNT-A in adult patients treated for muscle overactivity resulting from stroke, TBI and ACP summarizes commonly treated limb patterns, the trends in dosing, selected muscles and treatment sessions. Our experience can be used to guides others in this useful treatment strategy.
Botulinum toxin type-A (BoNT-A) treatment interventions in stroke, traumatic brain injury and adults with cerebral palsy related muscle overactivity. A 5 year retrospective study
CIONI, Matteo;
2009-01-01
Abstract
Botulinum Toxin Type-A (BoNT-A) treatment interventions in stroke, traumatic brain injury and adults with cerebral palsy related muscle overactivity: A six-year retrospective review Alberto Esquenazi, MD*; Nathaniel Mayer, MD*; Stella Kim, MPA* and Matteo Cioni, MD† Theera Vachranukunkiet, MD* *MossRehab Gait and Motor Control Analysis Laboratories, Philadelphia, PA; †Department of Experimental & Clinical Pharmacology University of Catania, Italy. Objective: To determine the patterns of Botulinum Toxin Type-A (BoNT-A) injection muscle selection, dosing and frequency of intervention associated with muscle overactivity in stroke, traumatic brain injury (TBI) and adult cerebral palsy (ACP) patients. Materials and Methods: Design: Retrospective review of data collected from 2003-2008. Setting: Gait & Motor Control Analysis Laboratories in a tertiary rehabilitation hospital. Participants: Data on 461 patients (1,430 sessions). Interventions: Clinically indicated BoNT-A injections for muscle overactivity. Main Outcome Measures: Patient demographics, limbs treated, muscle selection, treatment dose and frequency of treatment over time. Results: Data comprised of 461 patients (57.7% stroke, 27.5% TBI and 14.8% ACP). Average age at initial visit was 49 years (range, 18-89y). More than half of the patients were men (53.8%). Over forty percent of the patients had right side involvement, but for the stroke group 28.9% had left hemiparesis. There was no statistical significance between diagnosis and dose. However, the average number of muscles injected was less in ACP and in TBI patients compared to stoke patients. Average treatment dose for the lower limb was 300.0 122.4 and 288.7 149.0 units for the upper limb. Commonly treated patterns in the upper and lower limbs included: flexed wrist/fingers and the equinovarus foot. The flexor digitorum superficialis (FDS) was the most commonly injected muscle (26.5%) for the flexed wrist/fingers. The medial/lateral gastrocnemius muscles (40.3%) were the most frequently treated muscles for the equinovarus foot deformity. Treatment sessions ranged from 1 to 18 with an average of 3.1 treatment visits. Conclusions: This long term review in the management of BoNT-A in adult patients treated for muscle overactivity resulting from stroke, TBI and ACP summarizes commonly treated limb patterns, the trends in dosing, selected muscles and treatment sessions. Our experience can be used to guides others in this useful treatment strategy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
