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[Post stroke hemiplegia: lower limb benefit from botulinum toxin (review)]
1Service de médecine physique et de réadaptation, GH Lariboisière-F-Widal, AP-HP, 200, rue du Faubourg-Saint-Denis, 75010 Paris, France. alain.yelnik@lrb.ap-hop-paris.fr
Objective:
To clarify the conditions governing the use of botulinum toxin (BTX) for post-stroke lower limb spastic disorders: indications, choice of muscles, doses, and duration of efficacy.
Method:
Review of the international literature using the Medline and the Reedoc data banks.
Results:
Seven controlled studies were reviewed, including in particular 2 studies vs placebo and one vs phenol, 7 open studies or case series closely related to this topic and 4 open studies partly dedicated to it. The usefulness of BTX for the treatment of equinovarus has been demonstrated. The main muscles to be treated are the soleus, gastrocnemius and tibialis posterior. The treatment proposed for toe clawing is BTX injection into the flexor digitorum longus and flexor hallucis longus, and for great toe permanent extension, injection of the extensor hallucis longus. The quadriceps femoris, the tibialis anterior or the hamstrings have only be treated in isolated cases. When the treatment is effective, its benefit may last for more than 6 months.
Discussion:
A few controlled trials have demonstrated the efficacy of BTX for post stroke lower limb spasticity. The results of all the controlled and open trials argue in favor of its efficacy, but this still requires more thorough analysis.
Conclusion:
Botulinum toxin has a place together with other local treatments for post-stroke spasticity, but a precise guide to its use, especially its dosage, and it's effectiveness compared to that of other treatments, need further study.