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Focal Shock Waves Increase Efficacy and Prolong the Effect of Botulinum Toxin on Spasticity in Patients With Brain
Antonio Déniz1, Pedro Saavedra, Isabel Marrero
1From the Neurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr Negrín, Las Palmas, Spain (AD); Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas, Spain (PS), Physiology, Department of Biochemistry and Molecular Biology, Physiology, University of Las Palmas de Gran Canaria, Las Palmas, Spain (IM), and Faculty of Health Science, University of Las Palmas de Gran Canaria, Las Palmas, Spain (JH).
Objective:
The aim of the study is to assess the effects on spasticity reduction of the association between focal extracorporeal shock wave therapy and botulinum toxin type A, versus the toxin only in brain injury patients.
Design:
Eighteen patients were included. The study had two phases: the first phase was observational, and botulinum toxin type A was used. The second was a prospective, deliberate intervention phase in which the toxin was injected and focal extracorporeal shock wave treatment was added (1 sessions/week, for 3 wks). The patients were followed up in the 1st, 4th, and 6th month, the Ashworth Scale criterion was applied, and for those with lower limb involvement and changes in walking, the 10-meter walk test was used.
Results:
Patients treated with toxin only showed a statistically significant improvement in spasticity, with 1 point on the Ashworth Scale from week 5, which disappeared at week 17. However, the combined therapy reduced spasticity by 2 points from week 1 to week 25 ( P < 0.001), with a faster result in the 10-meter gait test ( P = 0.004).
Conclusions:
Combined and simultaneous treatment with botulinum toxin and focal extracorporeal shock wave reduced spasticity in a more effective and prolonged way than treatment with botulinum toxin only.
