The effect of botulinum toxin on gait analysis of paraplegic patients with lower limb spasticity
Keywords:
Botulinum Toxin, Spasticity, Spinal Cord Injury
Abstract
Often, people who have suffered spinal cord injury or stroke present spasticity in the lower extremities, due to uncontrolled muscle spasms, walking is completely prevented. Thus, to treat spasticity and regain walking, existing treatments include medications with substances that act on the central nervous system, such as baclofen, and substances whose infusion causes muscle denervation, such as botulinum toxin. The purpose of this study is to analyze the effect of botulinum toxin on lower extremity spasticity in paraplegic patients, and its contribution, when injected into selected muscle areas, to reduce focal hyperactivity. Research is also made, to determine the role of botulinum toxin in rehabilitation programs, when combined with other means, to improve quality of life in patients with spinal cord injury. For this review, research was made in Pubmed and Medline databases. The use of botulinum toxin issafe and effective, to reduce spasticity after spinal cord injury and other upper motor neuron damage. As for the improvements offered by botulinum toxin on walking,in patients with spinal cord injury, the results are indirect and related to the level of injury damage.In database, there are some articles with small sample of patients or case reports, so further research is needed to establish botulinum toxin’s ability to regain gait,on population that has suffered from spinal cord injury.
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References
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8. Yablon SA. Botulinum neurotoxin intramuscular chemodenervation. Role in the management of spastic hypertonia and related motor disorders. Phys Med Rehabil Clin N Am. 2001 Nov;12(4):833-74, vii-viii.
9. Richardson D, Sheean G, Werring D, et al. Evaluating the role of botulinum toxin in the management of focal hypertonia in adults. J Neurol Neurosurg Psychiatry. 2000 Oct;69(4):499-506.
10. Bravo-Esteban E, Taylor J, Abián-Vicén J, et al. Impact of specific symptoms of spasticity on voluntary lower limb muscle function, gait and daily activities during subacute and chronic spinal cord injury. NeuroRehabilitation. 2013;33(4):531-43. doi: 10.3233/NRE-131000.
11. Marciniak C, Rader L, Gagnon C. The use of botulinum toxin for spasticity after spinal cord injury. Am J Phys Med Rehabil. 2008 Apr;87(4):312-7; quiz 318-20, 329. doi: 10.1097/PHM.0b013e318168ceaf.
12. Al-Khodairy AT, Gobelet C, Rossier AB. Has botulinum toxin type A a place in the treatment of spasticity in spinal cord injury patients? Spinal Cord. 1998 Dec;36(12):854-8.
13. Krawetz P, Nance P. Gait analysis of spinal cord injured subjects: effects of injury level and spasticity. Arch Phys Med Rehabil. 1996 Jul;77(7):635-8.
14. Patrick JH. Case for gait analysis as part of the management of incomplete spinal cord injury. Spinal Cord. 2003 Sep;41(9):479-82.
15. Barroso FO, Torricelli D, Bravo-Esteban E, et al. Muscle Synergies in Cycling after Incomplete Spinal Cord Injury: Correlation with Clinical Measures of Motor Function and Spasticity. Front Hum Neurosci. 2016 Jan 11;9:706. doi: 10.3389/fnhum.2015.00706. eCollection 2015.
16. Holanda LJ, Silva PMM, Amorim TC, et al. Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review. J Neuroeng Rehabil. 2017 Dec 4;14(1):126. doi: 10.1186/s12984-017-0338-7.
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18. Nam KY, Kim HJ, Kwon BS, et al. Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: a systematic review. J Neuroeng Rehabil. 2017 Mar 23;14(1):24. doi: 10.1186/s12984-017-0232-3.
19. Aach M, Cruciger O, Sczesny-Kaiser M, et al. Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study. Spine J. 2014 Dec 1;14(12):2847-53. doi: 10.1016/j.spinee.2014.03.042. Epub 2014 Apr 4.
20. Hortal E, Úbeda A, Iáñez E, et al. EEG-Based Detection of Starting and Stopping During Gait Cycle. Int J Neural Syst. 2016 Nov;26(7):1650029. doi: 10.1142/S0129065716500295. Epub 2016 Apr 4.
21. Gross R, Leboeuf F, Rémy-Néris O, et al. Unstable gait due to spasticity of the rectus femoris: gait analysis and motor nerve block. Ann Phys Rehabil Med. 2012 Dec;55(9-10):609-22. doi: 10.1016/j.rehab.2012.08.013. Epub 2012 Sep 25.
22. Lampire N, Roche N, Carne P, et al. Effect of botulinum toxin injection on length and lengthening velocity of rectus femoris during gait in hemiparetic patients. Clin Biomech (Bristol, Avon). 2013 Feb;28(2):164-70. doi: 10.1016/j.clinbiomech.2012.12.006. Epub 2013 Jan 16.
23. Alcocer-Gamboa MA, Ojeda-Manzano A, Baqueiro-Gongora LJ, Denis-Alcocer LE, Hattori-Hara M, Pacheco-Guemez A. Dose and efficacy of botulinum toxin in pediatric patients with spasticity. Rev Neurol. 2019 Sep 1;69(5):199-206. doi: 10.33588/rn.6905.2019110.
24. Choi JY, Kim SK, Park ES. The Effect of Botulinum Toxin Injections on Gross Motor Function for Lower Limb Spasticity in Children with Cerebral Palsy. Toxins (Basel). 2019 Nov 8;11(11). pii: E651. doi: 10.3390/toxins11110651.
25. Opara J, Hordyńska E, Swoboda A. Effectiveness of botulinum toxin A in the treatment of spasticity of the lower extremities in adults - preliminary report. Ortop Traumatol Rehabil. 2007 May-Jun;9(3):277-85.
26. Siongco PRL, Rosales RL, Moore AP, Freynhagen R, Arimura K, Kanovsky P, Kaji R, Fernandez HH, Dressler D. Botulinum neurotoxin injections for muscle-based (dystonia and spasticity) and non-muscle-based (neuropathic pain) pain disorders: a meta-analytic study. J Neural Transm (Vienna). 2020 Mar 7. doi: 10.1007/s00702-020-02163-5.
27. Park J, Chung ME. Botulinum Toxin for Central Neuropathic Pain. Toxins (Basel). 2018 Jun 1;10(6). pii: E224. doi: 10.3390/toxins10060224.
28. Lester J, Alvarez-Resendiz GE, Klériga E, Videgaray F, Zambito G. Treatment with Botulinum Toxin for Refractory Fever Caused by Severe Spasticity: A Case Series. Neurol Ther. 2018 Jun;7(1):155-159. doi: 10.1007/s40120-018-0092-1. Epub 2018 Jan 30.
29. Chang E, Ghosh N, Yanni D, Lee S, Alexandru D, Mozaffar T. A Review of Spasticity Treatments: Pharmacological and Interventional Approaches. Crit Rev Phys Rehabil Med. 2013;25(1-2):11-22.
30. Vogt T, Urban PP. Optimized therapy of spastic syndrome by combination intrathecal baclofen with botulinum toxin. Nervenarzt. 2000 Dec;71(12):1007-11.
31. Rekand T, Hagen EM, Grønning M. Spasticity following spinal cord injury. Tidsskr Nor Laegeforen. 2012 Apr 30;132(8):970-3. doi: 10.4045/tidsskr.10.0872.
32. Yan X, Lan J, Liu Y, Miao J. Efficacy and Safety of Botulinum Toxin Type A in Spasticity Caused by Spinal Cord Injury: A Randomized, Controlled Trial. Med Sci Monit. 2018 Nov 13;24:8160-8171. doi: 10.12659/MSM.911296.
33. Selimoglu E, Turgut ST, Akpinar P, Yumusakhuylu Y, Haliloglu S, Baklacioglu HS, Icagasioglu A. Effect of botulinum toxin type-A in patients with focal spasticity. North Clin Istanb. 2015 Jan 24;1(3):153-157. doi: 10.14744/nci.2014.43531. eCollection 2014.
34. Santamato A, Panza F, Ranieri M, Amoruso MT, Amoruso L, Frisardi V, Solfrizzi V, Fiore P. Effect of intrathecal baclofen, botulinum toxin type A and a rehabilitation programme on locomotor function after spinal cord injury: a case report. J Rehabil Med. 2010 Oct;42(9):891-4. doi: 10.2340/16501977-0596.
35. Farag J, Reebye R, Ganzert C, Mills P. Does casting after botulinum toxin injection improve outcomes in adults with limb spasticity? A systematic review. J Rehabil Med. 2020 Jan 2;52(1):jrm00005. doi: 10.2340/16501977-2629.
36. Sobolewski P. The application of botulinum toxin type A in the treatment of spastic paraparesis. Przegl Lek. 2007;64 Suppl 2:3-7.
2. Spiegl UJ, Maier D, Gonschorek O, et al. Antispastic therapy with botulinum toxin type A in patients with traumatic spinal cord lesion. GMS Interdiscip Plast Reconstr Surg DGPW. 2014 Dec 10;3:Doc14. doi: 10.3205/iprs000055. eCollection 2014.
3. Palazón-García R, Alcobendas-Maestro M, Esclarin-de Ruz A, et al. Treatment of spasticity in spinal cord injury with botulinum toxin. J Spinal Cord Med. 2019 May;42(3):281-287. doi: 10.1080/10790268.2018.1479053. Epub 2018 Jun 5.
4. Montecucco C, Molgó J. Botulinal neurotoxins: revival of an old killer. Curr Opin Pharmacol. 2005 Jun;5(3):274-9.
5. Vasiliadis ES, Savvidou OD, Psarakis S, et al. The use of botulinum toxin in Orthopaedics. Ostoun. 2009 20 (4): 229-237.
6. Baba MDY, Osborne M D MD, Wszolek M D ZK, et al. Treatment of spasticity with botulinum toxin. Ortop Traumatol Rehabil. 2004 Oct 30;6(5):665-72.
7. Camargo CHF, Teive HAG. Use of botulinum toxin for movement disorders. Drugs Context. 2019 Jun 18;8:212586. doi: 10.7573/dic.212586. eCollection 2019.
8. Yablon SA. Botulinum neurotoxin intramuscular chemodenervation. Role in the management of spastic hypertonia and related motor disorders. Phys Med Rehabil Clin N Am. 2001 Nov;12(4):833-74, vii-viii.
9. Richardson D, Sheean G, Werring D, et al. Evaluating the role of botulinum toxin in the management of focal hypertonia in adults. J Neurol Neurosurg Psychiatry. 2000 Oct;69(4):499-506.
10. Bravo-Esteban E, Taylor J, Abián-Vicén J, et al. Impact of specific symptoms of spasticity on voluntary lower limb muscle function, gait and daily activities during subacute and chronic spinal cord injury. NeuroRehabilitation. 2013;33(4):531-43. doi: 10.3233/NRE-131000.
11. Marciniak C, Rader L, Gagnon C. The use of botulinum toxin for spasticity after spinal cord injury. Am J Phys Med Rehabil. 2008 Apr;87(4):312-7; quiz 318-20, 329. doi: 10.1097/PHM.0b013e318168ceaf.
12. Al-Khodairy AT, Gobelet C, Rossier AB. Has botulinum toxin type A a place in the treatment of spasticity in spinal cord injury patients? Spinal Cord. 1998 Dec;36(12):854-8.
13. Krawetz P, Nance P. Gait analysis of spinal cord injured subjects: effects of injury level and spasticity. Arch Phys Med Rehabil. 1996 Jul;77(7):635-8.
14. Patrick JH. Case for gait analysis as part of the management of incomplete spinal cord injury. Spinal Cord. 2003 Sep;41(9):479-82.
15. Barroso FO, Torricelli D, Bravo-Esteban E, et al. Muscle Synergies in Cycling after Incomplete Spinal Cord Injury: Correlation with Clinical Measures of Motor Function and Spasticity. Front Hum Neurosci. 2016 Jan 11;9:706. doi: 10.3389/fnhum.2015.00706. eCollection 2015.
16. Holanda LJ, Silva PMM, Amorim TC, et al. Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review. J Neuroeng Rehabil. 2017 Dec 4;14(1):126. doi: 10.1186/s12984-017-0338-7.
17. Stampacchia G, Rustici A, Bigazzi S, et al. Walking with a powered robotic exoskeleton: Subjective experience, spasticity and pain in spinal cord injured persons. Neuro Rehabilitation. 2016 Jun 27;39(2):277-83. doi: 10.3233/NRE-161358.
18. Nam KY, Kim HJ, Kwon BS, et al. Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: a systematic review. J Neuroeng Rehabil. 2017 Mar 23;14(1):24. doi: 10.1186/s12984-017-0232-3.
19. Aach M, Cruciger O, Sczesny-Kaiser M, et al. Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study. Spine J. 2014 Dec 1;14(12):2847-53. doi: 10.1016/j.spinee.2014.03.042. Epub 2014 Apr 4.
20. Hortal E, Úbeda A, Iáñez E, et al. EEG-Based Detection of Starting and Stopping During Gait Cycle. Int J Neural Syst. 2016 Nov;26(7):1650029. doi: 10.1142/S0129065716500295. Epub 2016 Apr 4.
21. Gross R, Leboeuf F, Rémy-Néris O, et al. Unstable gait due to spasticity of the rectus femoris: gait analysis and motor nerve block. Ann Phys Rehabil Med. 2012 Dec;55(9-10):609-22. doi: 10.1016/j.rehab.2012.08.013. Epub 2012 Sep 25.
22. Lampire N, Roche N, Carne P, et al. Effect of botulinum toxin injection on length and lengthening velocity of rectus femoris during gait in hemiparetic patients. Clin Biomech (Bristol, Avon). 2013 Feb;28(2):164-70. doi: 10.1016/j.clinbiomech.2012.12.006. Epub 2013 Jan 16.
23. Alcocer-Gamboa MA, Ojeda-Manzano A, Baqueiro-Gongora LJ, Denis-Alcocer LE, Hattori-Hara M, Pacheco-Guemez A. Dose and efficacy of botulinum toxin in pediatric patients with spasticity. Rev Neurol. 2019 Sep 1;69(5):199-206. doi: 10.33588/rn.6905.2019110.
24. Choi JY, Kim SK, Park ES. The Effect of Botulinum Toxin Injections on Gross Motor Function for Lower Limb Spasticity in Children with Cerebral Palsy. Toxins (Basel). 2019 Nov 8;11(11). pii: E651. doi: 10.3390/toxins11110651.
25. Opara J, Hordyńska E, Swoboda A. Effectiveness of botulinum toxin A in the treatment of spasticity of the lower extremities in adults - preliminary report. Ortop Traumatol Rehabil. 2007 May-Jun;9(3):277-85.
26. Siongco PRL, Rosales RL, Moore AP, Freynhagen R, Arimura K, Kanovsky P, Kaji R, Fernandez HH, Dressler D. Botulinum neurotoxin injections for muscle-based (dystonia and spasticity) and non-muscle-based (neuropathic pain) pain disorders: a meta-analytic study. J Neural Transm (Vienna). 2020 Mar 7. doi: 10.1007/s00702-020-02163-5.
27. Park J, Chung ME. Botulinum Toxin for Central Neuropathic Pain. Toxins (Basel). 2018 Jun 1;10(6). pii: E224. doi: 10.3390/toxins10060224.
28. Lester J, Alvarez-Resendiz GE, Klériga E, Videgaray F, Zambito G. Treatment with Botulinum Toxin for Refractory Fever Caused by Severe Spasticity: A Case Series. Neurol Ther. 2018 Jun;7(1):155-159. doi: 10.1007/s40120-018-0092-1. Epub 2018 Jan 30.
29. Chang E, Ghosh N, Yanni D, Lee S, Alexandru D, Mozaffar T. A Review of Spasticity Treatments: Pharmacological and Interventional Approaches. Crit Rev Phys Rehabil Med. 2013;25(1-2):11-22.
30. Vogt T, Urban PP. Optimized therapy of spastic syndrome by combination intrathecal baclofen with botulinum toxin. Nervenarzt. 2000 Dec;71(12):1007-11.
31. Rekand T, Hagen EM, Grønning M. Spasticity following spinal cord injury. Tidsskr Nor Laegeforen. 2012 Apr 30;132(8):970-3. doi: 10.4045/tidsskr.10.0872.
32. Yan X, Lan J, Liu Y, Miao J. Efficacy and Safety of Botulinum Toxin Type A in Spasticity Caused by Spinal Cord Injury: A Randomized, Controlled Trial. Med Sci Monit. 2018 Nov 13;24:8160-8171. doi: 10.12659/MSM.911296.
33. Selimoglu E, Turgut ST, Akpinar P, Yumusakhuylu Y, Haliloglu S, Baklacioglu HS, Icagasioglu A. Effect of botulinum toxin type-A in patients with focal spasticity. North Clin Istanb. 2015 Jan 24;1(3):153-157. doi: 10.14744/nci.2014.43531. eCollection 2014.
34. Santamato A, Panza F, Ranieri M, Amoruso MT, Amoruso L, Frisardi V, Solfrizzi V, Fiore P. Effect of intrathecal baclofen, botulinum toxin type A and a rehabilitation programme on locomotor function after spinal cord injury: a case report. J Rehabil Med. 2010 Oct;42(9):891-4. doi: 10.2340/16501977-0596.
35. Farag J, Reebye R, Ganzert C, Mills P. Does casting after botulinum toxin injection improve outcomes in adults with limb spasticity? A systematic review. J Rehabil Med. 2020 Jan 2;52(1):jrm00005. doi: 10.2340/16501977-2629.
36. Sobolewski P. The application of botulinum toxin type A in the treatment of spastic paraparesis. Przegl Lek. 2007;64 Suppl 2:3-7.
Published
2021-08-20
Section
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