Clinical Efficacy of a Double Injection Protocol of Botulinum Toxin Type A for Upper Limb Hemiparesis after Stroke

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  • 竹川 徹
    東京慈恵会医科大学リハビリテーション医学講座
  • 原 貴敏
    東京慈恵会医科大学リハビリテーション医学講座
  • 角田 亘
    東京慈恵会医科大学リハビリテーション医学講座
  • 小林 一成
    東京慈恵会医科大学リハビリテーション医学講座
  • 佐瀬 洋輔
    東京慈恵会医科大学附属病院リハビリテーション科
  • 安保 雅博
    東京慈恵会医科大学リハビリテーション医学講座

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Other Title
  • 《原著》 脳卒中後の上肢痙縮への2度のA型ボツリヌス毒素投与が上肢運動機能へ与える効果
  • 脳卒中後の上肢痙縮への2度のA型ボツリヌス毒素投与が上肢運動機能へ与える効果
  • ノウソッチュウ ゴ ノ ジョウシケイシュク エ ノ 2ド ノ Aガタ ボツリヌス ドクソ トウヨ ガ ジョウシ ウンドウ キノウ エ アタエル コウカ

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Abstract

Background : The aim of this study was to assess the effects of repeated injections of botulinum toxin type A (BoNT-A) combined with a rehabilitative program for treating spastic upper limb hemiparesis after stroke. Subjects and methods: Subjects were 112 poststroke hemiparetic patients with spastic upper limb (mean age : 55.5±11.6 years ±SD, mean period between onset and first injection : 5.1±3.5 years). For each patient, BoNT-A (maximum dose of each injection : 240 units) was injected in the spastic muscles of the affected upper limb twice with a minimum interval of 3 months. Following each injection, detailed one-to-one instructions for homebased functional training was provided. At the baseline (before injection) and at 1 and 3 month follow-ups after each injection, the patient's modified Ashworth scale (MAS), the range of motion (ROM) and Fugl-Meyer Assessment (FMA) were evaluated. Results : The total score for the upper limb and the scores of categories A and B of the FMA increased significantly not only after the first injection but after the second injection compared with the second baseline, while the FMA score for category D increased significantly only after the second injection. MAS also decreased significantly not only after the first injection but after the second injection compared to the second baseline. Conclusion : A more significant improvement was found not only in muscle spasticity but also in upper limb motor function after two BoNT-A injections. It is suggested that repeated BoNT-A injections followed by a comprehensive rehabilitative program would be an effective treatment for limb spasticity after a stroke.

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