http://www.ncbi.nlm.nih.gov/pubmed/9862538
Abstract
Locally
acting treatments for spasticity such as nerve and motor point blocks
have the advantage of reducing harmful spasticity in one area, while
preserving useful spasticity in another area. This randomized,
double-blind study is the first trial that was designed to find out
whether botulinus toxin Type A and phenol relieves the signs and
symptoms of ankle plantar flexor and foot invertor spasticity after
stroke and if either of these methods offers any advantages and
disadvantages over the other. Twenty patients who were included in this
preliminary study were randomly assigned to receive a single treatment
of 400 mouse units of botulinus toxin Type A injected into the calf
muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. A
combination of subjective and objective measures were used to assess
functional change at baseline and at Weeks 2, 4, 8, and 12. At
follow-up, significant improvement (P < 0.05) in the Ashworth score
for dorsiflexion was observed in both groups. The change in the Ashworth
score for eversion was significant in the group that received botulinus
toxin Type A (P < 0.05) but not in the group that received phenol (P
> 0.05). When those variables were compared between the two groups,
the change in the Ashworth score at Weeks 2 and 4 was significantly
better in the group that received botulinus toxin Type A (P < 0.05)
but there was not a significant difference between the two groups at
Weeks 8 and 12 (P > 0.05). The decrease in clonus duration that was
detected by electromyography was significant in both groups at all
visits, but the decrease in the group that received botulinus toxin Type
A was significantly better at Weeks 2 and 4 (P < 0.05). It is
concluded that both motor point injections with botulinus toxin Type A
and tibial nerve blockade with phenol are effective in plantar flexor
spasticity, but the changes were more significant in the group that
received botulinus toxin Type A at Weeks 2 and 4, whereas there was not a
significant difference between the two groups at Weeks 8 and 12. Future
research should explore the long-term effect of these two treatment
modalities.
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