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[Botulinum toxin injections and hypertonic upper limbs. Which functional results?].
A-L Ferrapie1, A Vieillart, Y Saint-Cast
1CRRRF, CHU de Angers, France. annelaure.ferrapie@c3rf-angers.asso.fr
Summary
Botulinum toxin injections effectively improve function, reduce pain, and enhance grip in hypertonic upper limbs. This treatment is beneficial even for the non-dominant hand, requiring targeted muscle injections and neurostimulation for optimal results.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Medical Aesthetics
Background:
- Upper motor neuron syndrome can cause hypertonic upper limbs, impacting hand function.
- Residual motricity in the hand allows for potential functional gains.
- Botulinum toxin is a potential therapeutic agent for managing spasticity.
Purpose of the Study:
- To evaluate the efficacy of botulinum toxin injections for hypertonic upper limbs.
- To assess functional improvements in patients with residual hand motricity.
- To determine the impact on impairment, pain, and prehension.
Main Methods:
- Prospective study of 8 patients with hypertonic upper limbs.
- Botulinum toxin injections guided by neurostimulation.
- Assessment of range of motion, spasticity (Ashworth scale), pain (VAS), and prehension (400-point measure).
- Predefined functional goals and patient satisfaction were recorded.
Main Results:
- Significant reduction in pain (mean 3.4 points) and spasticity (mean 1.0 point).
- Improved prehension, particularly for bimanual tasks.
- Seventy-five percent of functional goals were achieved.
- Repeated injections and adjusted dosages/targets enhanced efficacy.
Conclusions:
- Botulinum toxin injections are effective for hypertonic upper limbs, improving impairment, pain, and prehension.
- Functional gains are optimized with injections targeting both intrinsic and extrinsic muscles, utilizing neurostimulation.
- Assessment should include bimanual tasks, and further comparative studies are needed.