Have your doctor read this. I'm getting tired of pouring the same types of information into my brain.
http://www.karger.com/Article/Abstract/365005
Are they even considering that spasticity
occurs in about 30% of patients?
Yamada N. · Kakuda W. · Kondo T. · Mitani S. · Shimizu M. · Abo M.
aDepartment of Rehabilitation Medicine, Jikei University School of Medicine, Minato-Ku, Tokyo and
bShimizu Hospital, Kurayoshi, Tottori, Japan
Abstract
Background: The purpose of this study was
to determine whether local injection of botulinum toxin type A (BoNT-A)
into the spastic muscles has any added benefits to repetitive
transcranial magnetic stimulation (RTMS)/occupational therapy (OT) in
patients with spastic upper limb hemiparesis. Methods: The
study subjects of 80 post-stroke patients with spastic upper limb
hemiparesis (age: 60.2 ± 13.0 years, time after stroke: 55.3 ± 43.0
months), were divided into the BoNT-A plus RTMS/OT group and RTMS/OT
group. BoNT-A was injected into the spastic muscles (total dose: 240
units) before RTMS/OT. The latter included 12 sessions of 40 min RTMS
over the non-lesional hemisphere and 240-min intensive OT daily over 15
days. Spasticity was evaluated by the modified Ashworth scale (MAS) and
the motor function of the affected upper limb was evaluated serially
with Fugl-Meyer Assessment and Wolf Motor Function Tests. Results:
Both groups showed significant improvements in spasticity and motor
function. The addition of BoNT-A resulted in better improvement in FMA
score and MAS of finger flexor muscles (p < 0.05). Conclusions:
The triple-element protocol of local injection of BoNT-A into spastic
finger muscles, RTMS and intensive OT, is a promising therapeutic
program for post-stroke spastic upper limb hemiparesis, although its
significance should be confirmed in randomized, placebo-controlled
trials
