So no improvement seen in functional activity. Is your doctor still using botox after 8 years of knowing this? I saw zero improvement in my left arm functionality after my shots, 2 courses of them. Of course I wasn't treated with Sativex since that was after my stroke and I'm not in the UK.
Sativex, a cannabis based spray, was approved in England in 2019 for use in moderate to severe spasticity(only MS) when other treatments haven’t worked.
Currently, Sativex is not approved for any indication in the US, so you are totally screwed unless you are in a legal marijuana state and want to experiment on your own. But you can't, that would only be allowed if prescribed by your doctor. And your doctor will never prescribe marijuana.
Does Spasticity Reduction by Botulinum Toxin
Type A Improve Upper Limb Functionality in Adult Post-Stroke Patients? A
Systematic Review of Relevant Studies2013, Journal of Neurology & Neurophysiology Domenico Intiso
1
*, Valentina Simone
2
, Filomena Di Rienzo
1
, Andrea Santamato
3
, Mario Russo
1
, Maurizio Tolfa
1
, and Mario Basciani
1
1
Neuro-Rehabilitation Unit, Scientic Institute, Hospital ‘Casa Sollievo della Sofferenza’, Italy
2
Foundation rehabilitation “Gli Angeli di P.Pio”, San Giovanni Rotondo, Italy
3
Department of Physical Medicine and Rehabilitation, “OORR Hospital”, University of Foggia, Italy
*Corresponding author:
Domenico Intiso MD, Neuro-Rehabilitation Unit, Hospital
Scientic Institute “Casa Sollievo della Sofferenza”, Viale dei Cappuccini, 71013 San Giovanni Rotondo (FG), Italy, Tel: 039 882 410 942; Fax: 039 882 410 942; E-mail: d.intiso@operapadrepio.it
,
d.intiso@alice.it
Received
July 02, 2013;
Accepted
October
09, 2013;
Published
October
15
,
2013
Citation:
Intiso D, Simone
V, Rienzo FD
, Santamato A, Russo
M, et al.
(2013)
Does
Spasticity Reduction by Botulinum Toxin Type A Improve Upper Limb Functionality in Adult Post-Stroke Patients? A Systematic Review of Relevant Studies.
J Neurol
Neurophysiol 4: 167. doi:10.4172/2155-9562.1000167
Copyright:
© 2013
Intiso D
. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keyword
:
Botulinum toxin; Spasticity; Stroke; Upper limb; Functionality
Introduction
Spasticity is a common disabling disorder that occurs from 17 to 43% in patients with stroke affecting both the upper and the lower limb [1-4]. If le untreated, it can hamper functional outcome by promoting persistent abnormal posture that in turn produces muscular-tendon contractures and bone deformity. Several functional limitations arise from spasticity including impaired movement, hygiene, self-care, poor self-esteem, body image, pain and pressure ulcers that increase carer burden. Furthermore, patients with severe spasticity can develop poor social participation and quality of life (QOL) [5]. Because of these concerns and related high social costs [6], many therapeutic strategies have been proposed for the treatment of this disorder including surgical, medical and rehabilitative procedures. Among these, botulinum toxin type A (BTX-A) is became the first line to treat focal/multifocal spasticity, in the clinical practice. ere is now, a well-established body of evidence demonstrating the effectiveness of BTX-A for post-stroke spasticity reduction both in the upper and the lower limb [7-18]. Nevertheless, its impact on motor performance and functional outcome remains controversial [19,20]. In particular, the effect of reduced spasticity on upper limb ability recovery aer stroke is unclear. e central thread in treating spasticity is the assumption that it contributes to the limitation of activities, and that its reduction will bring about an improvement in function. e aim of present review was to ascertain if the reduction of spasticity by use of BTX-A was linked to a functional gain in upper limb or in activity of daily living in post-stroke patients. erefore, relevant studies addressing upper limb (UL) spasticity reduction and functional improvement aer BTX-A treatment in adult post-stroke patients were reviewed.
Method
Search of relevant studies was conducted on MEDLINE (from 1995 to July 2012), the Cochrane Central Register of Controlled Trials and EMBASE (1995 to July 2012). Search terms varied slightly across databases but included: “cerebrovascular accident” or “stroke” and the terms “botulinum toxin”, “spasticity” as either MeSH terms, key words, or subject headings. Only randomized studies (RT) treating patients with UL post-stroke spasticity by BTX-A injection were included. Studies of treatment for both lower and/or UL spasticity were included if the results for patients with UL spasticity were reported separately. Prospective open label, case series, cohort studies and case reports were excluded. Furthermore, because confounding results, RTs were also excluded whether: i) post-stroke spasticity was treated by different serotype neurotoxin; ii) botulinum toxin was given early aer the stroke, before clinical evidence of severe spasticity was established; iii) mixed sample of subjects with spasticity secondary to stroke or other neurological disorders was enrolled; iv) spasticity followed a non-
Abstract
Objective: Botulinum toxin type A (BTX-A) use reduces upper limb (UL) spasticity in stroke patients, but the effects on functional recovery remain uncertain. The aim of present review was to ascertain if the reduction of spasticity by use of BTX-A was linked to a functional gain of UL or in activity of daily living in post-stroke patients.
Data source: Search of relevant studies was conducted on MEDLINE, the Cochrane Central Register of Controlled Trials and EMBASE (1995 to July 2012).
Study selection: Only randomized studies (RT) treating patients with UL post-stroke spasticity by BTX-A injection were included. Prospective open label, case series, cohort studies and case reports were excluded.
Data synthesis: Thirty-four RTs were individuated, but only 16 were considered in the analysis. Trials varied widely in methodological design and measures used in assessing UL ability. Benet in UL functional recovery was reported in 13 studies, but only in six the result was signicant.
Conclusion: Some oriented-focused movements of UL unequivocally improve after reduced spasticity by BTX-A treatment, but evidence that arm functionality in adult post-stroke patients signicantly benet from this intervention is still doubt. No improvement in global functionality of activity daily living was observed.
2013, Journal of Neurology & Neurophysiology
Domenico Intiso
1
*, Valentina Simone
2
, Filomena Di Rienzo
1
, Andrea Santamato
3
, Mario Russo
1
, Maurizio Tolfa
1
, and Mario Basciani
1
1
Neuro-Rehabilitation Unit, Scientic Institute, Hospital ‘Casa Sollievo della Sofferenza’, Italy
2
Foundation rehabilitation “Gli Angeli di P.Pio”, San Giovanni Rotondo, Italy
3
Department of Physical Medicine and Rehabilitation, “OORR Hospital”, University of Foggia, Italy
*Corresponding author:
Domenico Intiso MD, Neuro-Rehabilitation Unit, Hospital
Scientic Institute “Casa Sollievo della Sofferenza”, Viale dei Cappuccini, 71013 San Giovanni Rotondo (FG), Italy, Tel: 039 882 410 942; Fax: 039 882 410 942; E-mail: d.intiso@operapadrepio.it
,
d.intiso@alice.it
Received
July 02, 2013;
Accepted
October
09, 2013;
Published
October
15
,
2013
Citation:
Intiso D, Simone
V, Rienzo FD
, Santamato A, Russo
M, et al.
(2013)
Does
Spasticity Reduction by Botulinum Toxin Type A Improve Upper Limb Functionality in Adult Post-Stroke Patients? A Systematic Review of Relevant Studies.
J Neurol
Neurophysiol 4: 167. doi:10.4172/2155-9562.1000167
Copyright:
© 2013
Intiso D
. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keyword
:
Botulinum toxin; Spasticity; Stroke; Upper limb; Functionality
Introduction
Spasticity is a common disabling disorder that occurs from 17 to 43% in patients with stroke affecting both the upper and the lower limb [1-4]. If le untreated, it can hamper functional outcome by promoting persistent abnormal posture that in turn produces muscular-tendon contractures and bone deformity. Several functional limitations arise from spasticity including impaired movement, hygiene, self-care, poor self-esteem, body image, pain and pressure ulcers that increase carer burden. Furthermore, patients with severe spasticity can develop poor social participation and quality of life (QOL) [5]. Because of these concerns and related high social costs [6], many therapeutic strategies have been proposed for the treatment of this disorder including surgical, medical and rehabilitative procedures. Among these, botulinum toxin type A (BTX-A) is became the first line to treat focal/multifocal spasticity, in the clinical practice. ere is now, a well-established body of evidence demonstrating the effectiveness of BTX-A for post-stroke spasticity reduction both in the upper and the lower limb [7-18]. Nevertheless, its impact on motor performance and functional outcome remains controversial [19,20]. In particular, the effect of reduced spasticity on upper limb ability recovery aer stroke is unclear. e central thread in treating spasticity is the assumption that it contributes to the limitation of activities, and that its reduction will bring about an improvement in function. e aim of present review was to ascertain if the reduction of spasticity by use of BTX-A was linked to a functional gain in upper limb or in activity of daily living in post-stroke patients. erefore, relevant studies addressing upper limb (UL) spasticity reduction and functional improvement aer BTX-A treatment in adult post-stroke patients were reviewed.
Method
Search of relevant studies was conducted on MEDLINE (from 1995 to July 2012), the Cochrane Central Register of Controlled Trials and EMBASE (1995 to July 2012). Search terms varied slightly across databases but included: “cerebrovascular accident” or “stroke” and the terms “botulinum toxin”, “spasticity” as either MeSH terms, key words, or subject headings. Only randomized studies (RT) treating patients with UL post-stroke spasticity by BTX-A injection were included. Studies of treatment for both lower and/or UL spasticity were included if the results for patients with UL spasticity were reported separately. Prospective open label, case series, cohort studies and case reports were excluded. Furthermore, because confounding results, RTs were also excluded whether: i) post-stroke spasticity was treated by different serotype neurotoxin; ii) botulinum toxin was given early aer the stroke, before clinical evidence of severe spasticity was established; iii) mixed sample of subjects with spasticity secondary to stroke or other neurological disorders was enrolled; iv) spasticity followed a non-
1
*, Valentina Simone
2
, Filomena Di Rienzo
1
, Andrea Santamato
3
, Mario Russo
1
, Maurizio Tolfa
1
, and Mario Basciani
1
1
Neuro-Rehabilitation Unit, Scientic Institute, Hospital ‘Casa Sollievo della Sofferenza’, Italy
2
Foundation rehabilitation “Gli Angeli di P.Pio”, San Giovanni Rotondo, Italy
3
Department of Physical Medicine and Rehabilitation, “OORR Hospital”, University of Foggia, Italy
*Corresponding author:
Domenico Intiso MD, Neuro-Rehabilitation Unit, Hospital
Scientic Institute “Casa Sollievo della Sofferenza”, Viale dei Cappuccini, 71013 San Giovanni Rotondo (FG), Italy, Tel: 039 882 410 942; Fax: 039 882 410 942; E-mail: d.intiso@operapadrepio.it
,
d.intiso@alice.it
Received
July 02, 2013;
Accepted
October
09, 2013;
Published
October
15
,
2013
Citation:
Intiso D, Simone
V, Rienzo FD
, Santamato A, Russo
M, et al.
(2013)
Does
Spasticity Reduction by Botulinum Toxin Type A Improve Upper Limb Functionality in Adult Post-Stroke Patients? A Systematic Review of Relevant Studies.
J Neurol
Neurophysiol 4: 167. doi:10.4172/2155-9562.1000167
Copyright:
© 2013
Intiso D
. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keyword
:
Botulinum toxin; Spasticity; Stroke; Upper limb; Functionality
Introduction
Spasticity is a common disabling disorder that occurs from 17 to 43% in patients with stroke affecting both the upper and the lower limb [1-4]. If le untreated, it can hamper functional outcome by promoting persistent abnormal posture that in turn produces muscular-tendon contractures and bone deformity. Several functional limitations arise from spasticity including impaired movement, hygiene, self-care, poor self-esteem, body image, pain and pressure ulcers that increase carer burden. Furthermore, patients with severe spasticity can develop poor social participation and quality of life (QOL) [5]. Because of these concerns and related high social costs [6], many therapeutic strategies have been proposed for the treatment of this disorder including surgical, medical and rehabilitative procedures. Among these, botulinum toxin type A (BTX-A) is became the first line to treat focal/multifocal spasticity, in the clinical practice. ere is now, a well-established body of evidence demonstrating the effectiveness of BTX-A for post-stroke spasticity reduction both in the upper and the lower limb [7-18]. Nevertheless, its impact on motor performance and functional outcome remains controversial [19,20]. In particular, the effect of reduced spasticity on upper limb ability recovery aer stroke is unclear. e central thread in treating spasticity is the assumption that it contributes to the limitation of activities, and that its reduction will bring about an improvement in function. e aim of present review was to ascertain if the reduction of spasticity by use of BTX-A was linked to a functional gain in upper limb or in activity of daily living in post-stroke patients. erefore, relevant studies addressing upper limb (UL) spasticity reduction and functional improvement aer BTX-A treatment in adult post-stroke patients were reviewed.
Method
Search of relevant studies was conducted on MEDLINE (from 1995 to July 2012), the Cochrane Central Register of Controlled Trials and EMBASE (1995 to July 2012). Search terms varied slightly across databases but included: “cerebrovascular accident” or “stroke” and the terms “botulinum toxin”, “spasticity” as either MeSH terms, key words, or subject headings. Only randomized studies (RT) treating patients with UL post-stroke spasticity by BTX-A injection were included. Studies of treatment for both lower and/or UL spasticity were included if the results for patients with UL spasticity were reported separately. Prospective open label, case series, cohort studies and case reports were excluded. Furthermore, because confounding results, RTs were also excluded whether: i) post-stroke spasticity was treated by different serotype neurotoxin; ii) botulinum toxin was given early aer the stroke, before clinical evidence of severe spasticity was established; iii) mixed sample of subjects with spasticity secondary to stroke or other neurological disorders was enrolled; iv) spasticity followed a non-
Abstract
Objective:Botulinum toxin type A (BTX-A) use reduces upper limb (UL) spasticity in stroke patients, but the effects on functional recovery remain uncertain. The aim of present review was to ascertain if the reduction of spasticity by use of BTX-A was linked to a functional gain of UL or in activity of daily living in post-stroke patients.
Data source:
Search of relevant studies was conducted on MEDLINE, the Cochrane Central Register of Controlled Trials and EMBASE (1995 to July 2012).
Study selection:
Only randomized studies (RT) treating patients with UL post-stroke spasticity by BTX-A injection were included. Prospective open label, case series, cohort studies and case reports were excluded.
Data synthesis:
Thirty-four RTs were individuated, but only 16 were considered in the analysis. Trials varied widely in methodological design and measures used in assessing UL ability. Benet in UL functional recovery was reported in 13 studies, but only in six the result was signicant.
Conclusion:
Some oriented-focused movements of UL unequivocally improve after reduced spasticity by BTX-A treatment, but evidence that arm functionality in adult post-stroke patients signicantly benet from this intervention is still doubt. No improvement in global functionality of activity daily living was observed.
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