# LONG-TERM REPEATED BOTULINUM TOXIN A TREATMENT OVER 12 YEARS GRADUALLY CHANGES GAIT CHARACTERISTICS: SINGLE-CASE STUDY

## TL;DR

A woman received botulinum toxin A injections 30 times over 12 years, gradually improving her gait and reducing spasticity without adverse effects.

## Contribution

This single-case study shows that repeated botulinum toxin A injections over years can cumulatively improve gait and spasticity.

## Key findings

- Gait velocity and spasticity improved gradually over 30 injections.
- Some gait abnormalities like pes varus and circumduction showed improvement.
- Other gait issues like contralateral vaulting did not improve.

## Abstract

To demonstrate the long-term efficacy of repeated botulinum toxin A injections into the same muscles for ameliorating lower limb spasticity and gait function.

Single-case study

A 36-year-old woman with right cerebral haemorrhage received her first botulinum toxin A injection 1,296 days after onset. The patient underwent 30 treatments over 12 years after the first injection to improve upper and lower limb spasticity and abnormal gait patterns. The mean duration between injections was 147 days.

The Modified Ashworth Scale, passive range of motion, gait velocity, and degree of abnormal gait patterns during treadmill gait were evaluated pre-injection and at 2, 6, and 12 weeks after every injection.

The follow-up period showed no injection-related adverse events. Comfortable overground gait velocity gradually improved over 30 injections. The Modified Ashworth Scale and passive range of motion improved after each injection. Pre-injection values of the degree of pes varus, circumduction, hip hiking, and knee extensor thrust improved gradually. However, the degree of contralateral vaulting, excessive lateral shift of the trunk, and insufficient knee flexion did not improve after 30 injections.

Repeated botulinum toxin A injections effectively improve abnormal gait patterns, even when a single injection cannot change these values.

Botulinum toxin A (BoNTA) is used to treat spasticity in the arms and legs of adult patients. We report a case of a woman who was treated with BoNTA 30 times over 12 years to improve limb spasticity and abnormal gait patterns. The range of motion improved after each injection, and some other features of her gait improved gradually. We did not observe any injection-related adverse events during the follow-up period. We conclude that repeated BoNTA injections can effectively improve some abnormal gait patterns and comfortable overground gait velocity, even when a single injection cannot change these values. Cumulative effects were also shown. The combination of BoNTA and rehabilitation may lead to better results.