The Effect of Repeated abobotulinumtoxinA (Dysport®) Injections on Walking Velocity in Persons with Spastic Hemiparesis Caused by Stroke or Traumatic Brain Injury.

Abstract

BACKGROUND:

Botulinum toxin (BoNT) injections were shown to improve muscle tone of limbs in patients with spasticity. However, limited data are available regarding the effects of repeated BoNT injections on walking ability.

OBJECTIVE:

To assess changes in walking velocity (WV), step length, and cadence under different test conditions after repeated treatment with abobotulinumtoxinA (aboBoNT-A; Dysport) in spastic lower limb muscles.

DESIGN:

Secondary analysis of an open-label, multiple-cycle extension (National Clinical Trials number NCT01251367) to a phase III, double-blind, randomized, placebo-controlled, single-treatment cycle study, in adults with chronic hemiparesis (NCT01249404).

SETTING:

Fifty-two centers across Australia, Belgium, the Czech Republic, France, Hungary, Italy, Poland, Portugal, Russia, Slovakia, and the United States.

PATIENTS:

352 Ambulatory adults (18-80 years) with spastic hemiparesis and gait dysfunction caused by stroke or traumatic brain injury, with a comfortable barefoot WV of 0.1 to 0.8 m/s.

INTERVENTIONS:

Up to four aboBoNT-A treatment cycles, administered to spastic lower limb muscles.

MAIN OUTCOME MEASUREMENTS:

Changes from baseline in comfortable and maximal barefoot and with shoes WV (m/s), step length (m/step), and cadence (steps/minutes).

RESULTS:

At Week 12 after four injections, WV improved by 0.08 to 0.10 m/s, step length by 0.03 to 0.04 m/step, and cadence by 3.9 to 6.2 steps/minutes depending on test condition (all P < .0001 to .0003 vs baseline). More patients (7% to 17%) became unlimited community ambulators (WV ≥0.8 m/s) across test conditions compared with baseline, with 39% of 151 patients classified as unlimited community ambulators in at least one test condition and 17% in all four test conditions.

CONCLUSIONS:

Clinically meaningful and statistically significant improvements in WV, step length, and cadence under all four test conditions were observed in patients with spastic hemiparesis after each aboBoNT-A treatment cycle.

• Authors: Alberto Esquenazi, Allison Brashear, Thierry Deltombe, Monika Rudzinska-Bar, Malgorzata Krawczyk, Alexander Skoromets, Michael W O'Dell, Anne-Sophie Grandoulier, Claire Vilain, Philippe Picaut, Jean-Michel Gracies
• Journal: PM & R : the journal of injury, function, and rehabilitation (PM R) Vol. 13 Issue 5 Pg. 488-495 (05 2021) ISSN: 1934-1563 [Electronic] United States
• PMID: 32741133 (Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 The Authors. PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A
• abobotulinumtoxinA

Topics

• Adult
• Botulinum Toxins, Type A (therapeutic use)
• Brain Injuries, Traumatic
• Humans
• Injections, Intramuscular
• Muscle Spasticity (drug therapy, etiology)
• Neuromuscular Agents (therapeutic use)
• Paresis (drug therapy, etiology)
• Stroke (complications, drug therapy)
• Treatment Outcome
• Walking