Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1996 Sep;61(3):265–269. doi: 10.1136/jnnp.61.3.265

A randomised, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients.

P Burbaud 1, L Wiart 1, J L Dubos 1, E Gaujard 1, X Debelleix 1, P A Joseph 1, J M Mazaux 1, B Bioulac 1, M Barat 1, A Lagueny 1
PMCID: PMC486549  PMID: 8795597

Abstract

OBJECTIVE: To confirm the apparent effectiveness of botulinum toxin (BTX) in hemiparetic patients with ankle plantar flexors and foot invertor spasticity. METHODS: Twenty three hemiparetic patients with spasticity of the ankle plantar flexors and foot invertors were included in a randomised double blind, placebo controlled study with BTX. Patients were examined on days 0, 30, 90, and 120 and received one injection of BTX and one of placebo in a random order at day 0 and day 90. RESULTS: Patients reported a clear subjective improvement in foot spasticity after BTX (P = 0.0014) but not after placebo. Significant changes were noted in Ashworth scale values for ankle extensors (P < 0.0001) and invertors (P = 0.0002), and for active ankle dorsiflexion (P = 0.0001). Gait velocity was slightly but not significantly (P = 0.0731) improved after BTX injections. The severity of spasticity did not modify treatment efficacy, but BTX was less effective in patients with longer duration of spasticity (P = 0.0081). CONCLUSION: The efficacy of BTX injections in the treatment of spastic foot suggests that BTX may be particularly useful during the first year after a stroke.

Full text

PDF
265

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bohannon R. W., Smith M. B. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987 Feb;67(2):206–207. doi: 10.1093/ptj/67.2.206. [DOI] [PubMed] [Google Scholar]
  2. Borg-Stein J., Pine Z. M., Miller J. R., Brin M. F. Botulinum toxin for the treatment of spasticity in multiple sclerosis. New observations. Am J Phys Med Rehabil. 1993 Dec;72(6):364–368. [PubMed] [Google Scholar]
  3. Cosgrove A. P., Graham H. K. Botulinum toxin A prevents the development of contractures in the hereditary spastic mouse. Dev Med Child Neurol. 1994 May;36(5):379–385. doi: 10.1111/j.1469-8749.1994.tb11863.x. [DOI] [PubMed] [Google Scholar]
  4. Das T. K., Park D. M. Botulinum toxin in treating spasticity. Br J Clin Pract. 1989 Nov;43(11):401–403. [PubMed] [Google Scholar]
  5. Dengler R., Neyer U., Wohlfarth K., Bettig U., Janzik H. H. Local botulinum toxin in the treatment of spastic drop foot. J Neurol. 1992 Aug;239(7):375–378. doi: 10.1007/BF00812153. [DOI] [PubMed] [Google Scholar]
  6. Dunne J. W., Heye N., Dunne S. L. Treatment of chronic limb spasticity with botulinum toxin A. J Neurol Neurosurg Psychiatry. 1995 Feb;58(2):232–235. doi: 10.1136/jnnp.58.2.232. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fugl-Meyer A. R., Jäskö L., Leyman I., Olsson S., Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13–31. [PubMed] [Google Scholar]
  8. Greene P., Fahn S., Diamond B. Development of resistance to botulinum toxin type A in patients with torticollis. Mov Disord. 1994 Mar;9(2):213–217. doi: 10.1002/mds.870090216. [DOI] [PubMed] [Google Scholar]
  9. Herz D. A., Looman J. E., Tiberio A., Ketterling K., Kreitsch R. K., Colwill J. C., Grin O. D., Jr The management of paralytic spasticity. Neurosurgery. 1990 Feb;26(2):300–306. doi: 10.1097/00006123-199002000-00018. [DOI] [PubMed] [Google Scholar]
  10. Hesse S., Lücke D., Malezic M., Bertelt C., Friedrich H., Gregoric M., Mauritz K. H. Botulinum toxin treatment for lower limb extensor spasticity in chronic hemiparetic patients. J Neurol Neurosurg Psychiatry. 1994 Nov;57(11):1321–1324. doi: 10.1136/jnnp.57.11.1321. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Koman L. A., Mooney J. F., 3rd, Smith B., Goodman A., Mulvaney T. Management of cerebral palsy with botulinum-A toxin: preliminary investigation. J Pediatr Orthop. 1993 Jul-Aug;13(4):489–495. doi: 10.1097/01241398-199307000-00013. [DOI] [PubMed] [Google Scholar]
  12. Konstanzer A., Ceballos-Baumann A. O., Dressnandt J., Conrad B. Lokale Injektionsbehandlung mit Botulinum-Toxin A bei schwerer Arm- und Beinspastik. Nervenarzt. 1993 Aug;64(8):517–523. [PubMed] [Google Scholar]
  13. Mémin B., Pollak P., Hommel M., Perret J. Traitement de la spasticité par la toxine botulique. Rev Neurol (Paris) 1992;148(3):212–214. [PubMed] [Google Scholar]
  14. Penn R. D., Savoy S. M., Corcos D., Latash M., Gottlieb G., Parke B., Kroin J. S. Intrathecal baclofen for severe spinal spasticity. N Engl J Med. 1989 Jun 8;320(23):1517–1521. doi: 10.1056/NEJM198906083202303. [DOI] [PubMed] [Google Scholar]
  15. Petrillo C. R., Knoploch S. Phenol block of the tibial nerve for spasticity: a long-term follow-up study. Int Disabil Stud. 1988;10(3):97–100. doi: 10.3109/09638288809164120. [DOI] [PubMed] [Google Scholar]
  16. Snow B. J., Tsui J. K., Bhatt M. H., Varelas M., Hashimoto S. A., Calne D. B. Treatment of spasticity with botulinum toxin: a double-blind study. Ann Neurol. 1990 Oct;28(4):512–515. doi: 10.1002/ana.410280407. [DOI] [PubMed] [Google Scholar]
  17. Thilmann A. F., Fellows S. J., Garms E. The mechanism of spastic muscle hypertonus. Variation in reflex gain over the time course of spasticity. Brain. 1991 Feb;114(Pt 1A):233–244. [PubMed] [Google Scholar]
  18. Young R. R., Delwaide P. J. Drug therapy: spasticity (first of two parts). N Engl J Med. 1981 Jan 1;304(1):28–33. doi: 10.1056/NEJM198101013040107. [DOI] [PubMed] [Google Scholar]
  19. Young R. R., Delwaide P. J. Drug therapy: spasticity (second of two parts). N Engl J Med. 1981 Jan 8;304(2):96–99. doi: 10.1056/NEJM198101083040207. [DOI] [PubMed] [Google Scholar]
  20. Zuber M., Sebald M., Bathien N., de Recondo J., Rondot P. Botulinum antibodies in dystonic patients treated with type A botulinum toxin: frequency and significance. Neurology. 1993 Sep;43(9):1715–1718. doi: 10.1212/wnl.43.9.1715. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES