Botulinum Toxin (BT) injection improves voluntary motor control in selected patients with post-stroke spasticity

The effect of Botulinum Toxin Type A injection on voluntary grip control was examined in a 53-year-old female. She sustained a hemorrhagic right middle cerebral artery stroke 5 years ago that resulted in finger flexor spasticity and residual weak finger/wrist extension. The patient received 50 units of botulinum toxin type A injections each to the motor points (2 sites each muscle) of left flexor digitorum superficialis and flexor digitorum profundus. Botulinum toxin injections led to weakness and tone reduction in the spastic finger flexors, but improved grip release time in grip initiation/release reaction time tasks. Improved release time was accompanied by shortened extensor EMG activity. Improvement in release time was possibly related to block co-contraction of finger flexors during voluntary finger extension. This case report demonstrated that Botulinum toxin injection improved voluntary motor control of the hand in a chronic stroke patient with residual finger extension.