# LONG-TERM EFFICACY OF SPASTICITY-CORRECTIVE SURGERY AND BOTULINUM TOXIN INJECTIONS FOR UPPER LIMB SPASTICITY TREATMENT

## TL;DR

This study found that surgery provides longer-lasting relief from upper limb spasticity compared to botulinum toxin injections.

## Contribution

The study compares the long-term efficacy of surgery and botulinum toxin for upper limb spasticity treatment.

## Key findings

- Surgery led to significantly greater reductions in spasticity compared to botulinum toxin.
- Surgical benefits were sustained, while botulinum toxin effects were temporary.
- Surgery improved range of motion, grip strength, and patient satisfaction more effectively.

## Abstract

To evaluate the long-term efficacy of spasticity-corrective surgery and botulinum toxin treatment in patients with upper limb spasticity.

Pretest-posttest quasi-experimental study.

Thirty-four patients with disabling spasticity.

Patients were divided into 2 groups based on their treatment preference: the surgery group, which underwent tendon lengthening/release (n = 17), and the botulinum toxin injection group (n = 17). The primary outcome measure was the Modified Ashworth Scale. Secondary outcomes included range of motion, grip strength, and activity performance. Assessments were conducted at baseline for both groups, at 3 months following botulinum toxin injection, and at 6 months following surgery, with an additional peak-effect evaluation for botulinum toxin at week 5.

The surgery group demonstrated significantly greater reductions in composite Modified Ashworth Scale scores, with a mean change of 2.7 (SD 0.8), compared to the botulinum toxin group (1.1, SD 0.6 at peak; 0.3, SD 0.5 at long-term; p < 0.001). Surgery also led to significantly larger improvements in range of motion, grip strength, task performance, and patient satisfaction. While botulinum toxin effects were transient, surgery provided sustained benefits.

Spasticity-corrective surgery achieves superior and longer-lasting benefits compared to botulinum toxin treatment in patients with disabling upper limb spasticity.

Spasticity is a condition where muscles contract uncontrollably, often occurring after injuries to the brain or spinal cord. This can cause complications like shortened muscles and difficulty performing daily tasks. This study evaluated the long-term effectiveness of 2 treatments for upper limb spasticity: surgery and botulinum toxin (BoNT) injections. Patients selected their preferred treatment, with 17 patients in each group. The primary outcome was on how much the spasticity improved, measured using the Modified Ashworth Scale (MAS). Secondary outcomes included range of motion and the ability to perform daily activities. Assessments were conducted before treatment, 3 months after BoNT injections, and 6 months after surgery, with an additional evaluation of BoNT’s peak effects at 5 weeks. The results showed that the surgery group experienced significantly greater improvements in MAS and secondary outcomes compared to the BoNT group. The benefits of surgery were long-lasting, while the effects of BoNT were temporary.