[The application of botulinum toxin type A in the treatment of spastic paraparesis]

The introduction of botulinum toxin type A (BTX-A) has brought a new approach to the treatment for spasticity and pain connected, in the patients with spastic paraparesis in course of multiple sclerosis, posttraumatic and angiogenic lesion of brain and spinal cord. Spasticity in these cases make care and rehabilitation difficult. The aim of the study was to assess the efficacy of BTX-A in the patients with spastic paraparesis.

The study included 12 patients (7 female and 5 male): 7 patients with multiple sclerosis, 3 patients after cervical cord injury and 2 patients after brain injury. The drugs were applicated in 2 doses: Dysport in doses of 1000 units and 2000 units, and Botox in doses of 200 units and 400 units. The drugs were injected bilaterally in groups of adductor muscles of a thigh or in groups of sura muscles, dependently on clinical needs. There was a 3-month break between injections. The results were evaluated 6 weeks after the application of BTX-A. The modificated Ashworth Scale and mRBB Scale were used.

After using lower doses of BTX-A only pain relief was achieved; after using higher doses of BTX-A statistically essential spasticity and pain relief were achieved and the range of passive movements in the examined articulations was increased.

1. BTX-A is an efficient drug relieving pain in patients with spastic paraparesis. 2. Only the use of high doses of BTX-A (bilaterally 400 units of Botox or 2000 units of Dysport) resulted in spasticity relief in lower extremities and significantly increased the range of passive movements in articulations, which made care and rehabilitation easier.