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Disabling overactivity of the extensor hallucis longus after stroke: clinical expression and efficacy of botulinum
Alain P Yelnik1, Florence M Colle, Isabelle V Bonan
1Physical Medicine and Rehabilitation Department, GH Lariboisière-Fernand Widal, Paris, France. alain.yelnik@lrb.ap-hop-paris.fr
Objectives:
To describe the clinical characteristics of persistent extension of the great toe related to overactivity of the extensor hallucis longus (EHL) after a stroke and to explore the efficacy of treatment with botulinum toxin type A.
Design:
Case series.
Setting:
A physical medicine and rehabilitation department in France.
Participants:
Eleven patients with hemiplegia disabled by overactivity of the EHL were classified according to the different ways in which that overactivity was triggered. Disability was related to pain in 5 patients, to shoe difficulties in 10 patients, and to varus foot in 6 patients.
Intervention:
Injection of botulinum toxin type A into the EHL.
Main Outcome Measures:
Efficacy was assessed on day 15 by triggering of pain, shoe difficulties, and varus deformity and by patients' subjective assessment on day 15, at 3 months, and at 6 months.
Results:
On day 15, EHL overactivity disappeared after 16 of the 18 injections in 10 patients; subjective assessment was very good for pain and shoe difficulties and remained good or very good at 3 months for 8 patients who received 12 injections.
Conclusion:
Botulinum toxin type A is effective in treating disability related to poststroke overactivity of the EHL.
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