Early Botulinum Toxin Type A Injection for Post-Stroke Spasticity: A Longitudinal Cohort Study

Area of Science:

• Neurology
• Rehabilitation Medicine
• Pharmacology

Background:

• Post-stroke spasticity (PSS) is a common complication affecting functional recovery.
• Botulinum toxin type A (BoNT-A) is a recommended treatment for PSS, typically used in the chronic phase.
• The optimal timing for initiating BoNT-A treatment after stroke onset remains unclear.

Purpose of the Study:

• To investigate the effect of the time interval between stroke onset and the first BoNT-A injection on PSS treatment outcomes.
• To determine if early intervention with BoNT-A leads to improved spasticity reduction.

Main Methods:

• A multicenter, longitudinal cohort study involving 83 stroke patients with PSS receiving their first BoNT-A injection.
• Patients were assessed using the Modified Ashworth Scale (MAS) at baseline and at 4, 12, and 24 weeks post-injection.
• Patients were categorized based on receiving BoNT-A within (≤90 days) or after (>90 days) 3 months from stroke onset.

Main Results:

• MAS scores significantly decreased at 4 and 12 weeks post-BoNT-A treatment, with no significant reduction at 24 weeks.
• Patients treated within 90 days of stroke onset showed a more sustained MAS reduction at 12 weeks compared to those treated later.
• The MAS scores at 4 and 12 weeks were higher for the >90 days group compared to the ≤90 days group, indicating less effective early spasticity control.

Conclusions:

• Initiating BoNT-A treatment for PSS within 3 months of stroke onset is recommended for greater muscle tone reduction at 1 and 3 months post-treatment.
• Early BoNT-A intervention may optimize the management of post-stroke spasticity and improve patient outcomes.
• Further research could explore long-term efficacy and optimal treatment protocols for early-stage PSS.