Article

The study asked whether an early botulinum toxin A (BTX-A) injection
in subacute stroke patients may prevent a disabling finger flexor stiffness six
months later. DESIGN: Single-blind, randomized pilot study. Setting: Inpatient
rehabilitation centre. SUBJECTS: Eighteen stroke patients, interval 4-6 weeks,
non-functional arm, Fugl-Meyer arm score (0-66) <20, beginning elevated finger
flexor tone, randomly allocated to group A or B. Interventions: In group A
patients 150 units BTX-A (Xeomin) injected into the deep and superficial finger
(100 units) and wrist flexors (50 units), no injection in group B patients.
Comprehensive rehabilitation in both groups. MAIN MEASURES: Primary variable was
the Modified Ashworth Scale score (0-5) of the finger flexors; secondary
variables were whole arm muscle tone with REPAS (a summary rating scale for
resistance to passive movement), its motor control with the Fugl-Meyer arm score,
and a disability scale, blindly assessed at T0 (start), T1 (four weeks) and T6
(six months). RESULTS: Homogeneous groups at T0. Significantly less finger flexor
stiffness in the BTX-A group at T1 and T6, the mean (SD) Modified Ashworth Scale
scores in group A (B) were: 1.7 +/- 0.5 (1.6 +/- 0.5) at T0; 0.4 +/- 0.5 (1.9 +/-
0.7) at T1; and 1.4 +/- 0.7 (2.4 +/- 0.9) at T6. Among the secondary measures,
the disability score, namely the items pain and passive nail trimming, was lower
in group A at T1 and T6. CONCLUSIONS: The results indicate an effect of early
BTX-A injection on finger flexor stiffness six months later, presumably
attributable to a reduced contracture development.
Effect size calculation
suggests inclusion of at least 17 patients per group excluding drop-outs in a warranted placebo-controlled trial.

Langue : ANGLAIS