Article

OBJECTIVE: To investigate the relationship between gastrocnemius muscle echo
intensity and response to botulinum toxin type A (BoNT-A) in patients with
spastic equinus foot resulting from stroke. DESIGN:
Cohort study. SETTING:
University hospital. PARTICIPANTS: Adult patients (N=56) with spastic equinus
foot resulting from stroke scheduled to receive BoNT-A injection into the
gastrocnemius muscle. INTERVENTIONS: All patients were injected with BoNT-A
(abobotulinumtoxinA) into the gastrocnemius muscle with an
ultrasonography-guided, multisite injection technique. The toxin dose was 250U
for the gastrocnemius medialis and 250U for the gastrocnemius lateralis (dilution
500U/2mL) in each patient. All patients were evaluated before and 4 weeks after
BoNT-A injection. MAIN OUTCOME MEASURES: Spastic gastrocnemius muscle echo
intensity visually graded with the Heckmatt scale. Clinical assessment of the
spastic gastrocnemius with the Modified Ashworth Scale, Tardieu Scale, and ankle
passive range of motion. RESULTS: Postintervention testing at 4 weeks showed
overall significant improvements in the clinical assessment of the spastic
gastrocnemius muscle. No significant change was observed in the echo muscle
intensity of the spastic gastrocnemius after BoNT-A injection. Post hoc
comparisons showed that all clinical outcomes were significantly better in those
patients with echo muscle intensity of the spastic gastrocnemius graded II on the
Heckmatt scale than those with grades III (P<.001) and IV
(P<.001) after
botulinum toxin injection. CONCLUSIONS: These findings support the hypothesis
that patients with higher spastic muscle echo intensity have a reduced response
to BoNT-A.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS