The Impact of Repeated Applications of Botulinum Toxin A on the Spasticity of the Upper Limb in Stroke Patient, Cohort Study

TL;DR

This study shows that repeated Botox injections over time significantly reduce spasticity and improve arm function in stroke patients more effectively than a single injection.

Contribution

The study uniquely demonstrates the cumulative benefits of multiple Botulinum Toxin A sessions in post-stroke spasticity management.

Findings

Patients receiving five Botox sessions showed greater improvement in spasticity scores than those with one session.

Repeated Botox treatments led to sustained and amplified functional improvements in arm movement.

Botox was particularly effective in reducing spasticity in elbow pronators, wrists, and finger flexors over time.

Abstract

Background: Spasticity is a muscle stiffness issue often caused by spinal cord or cerebral diseases, notably impairing stroke patients. This study aims to evaluate the long-term effectiveness of repeated Botulinum Toxin A injections on spasticity and arm function, to understand if the treatment’s effects accumulate or diminish over time. Methods: This study examines 85 stroke patients treated with one or five sessions of BTX-A injections between 2013 and 2019. Patients were divided into two groups based on the number of sessions and evaluated using Modified Ashworth Scores, Brunnstrom Stage, and Frenchay Arm Test. Results: This study includes 85 hemiplegic patients with an average age of around 50, and various muscle groups were treated with BTX-A injections. Group 2, who received five sessions, showed significantly greater improvement in MAS scores for certain muscle groups and had higher FAT scores compared to Group 1, who received just one session. Overall, BTX-A treatment led to significant improvements in MAS, Brunnstrom, and FAT scores across all patients. Conclusions: Our findings corroborate existing literature by affirming that Botox injections effectively mitigate spasticity and enhance arm functionality. Notably, our data reveal that repeated Botox treatments yield significantly greater benefits in reducing spasticity in the elbow pronators, wrists, and finger flexors compared to a single session. This study uniquely demonstrates the cumulative benefits of multiple BTX-A sessions, highlighting that repeated applications not only sustain but also amplify functional improvements over time. These results advocate for the feasibility and augmented effectiveness of administering a series of five Botox injections in the management of post-stroke spasticity.