Functional effects of botulinum toxin type A in the hip adductors and subsequent stretching in patients with hereditary spastic paraplegia.

Abstract

OBJECTIVE:

To investigate the functional effects of bilateral botulinum toxin A treatment and subsequent stretching of spastic hip adductors on gait and reactive lateral stepping responses in patients with pure hereditary spastic paraplegia.

DESIGN:

Explorative pre-post intervention study.

PATIENTS:

Twenty-five patients with pure hereditary spastic paraplegia.

METHODS:

Patients were treated with bilateral botulinum toxin A injections in the hip adductors and performed daily self-administered stretching exercises for 16 weeks. Before the intervention (T0), and 6 (T1) and 16 (T2) weeks thereafter, gait width, gait speed, and leg angles at first stepping-foot contact after lateral balance perturbations were assessed, as well as the corresponding success rates of reactive lateral steps.

RESULTS:

Compared with baseline, gait width increased by 12.6% and 9.7% and comfortable gait speed by 8.3% and 11.5% at T1 and T2, respectively. In known perturbation directions, leg angles increased by 5.9% at T1 and 8.0% at T2, while success rates increased from 70% at baseline to 90% at T1 and T2. No effects were found for maximal gait speed or lateral stepping responses in unknown perturbation directions.

CONCLUSION:

Bilateral botulinum toxin A treatment and subsequent stretching of the hip adductors may improve gait and reactive lateral stepping in patients with pure hereditary spastic paraplegia.

• Authors: Bas J H van Lith, Jasper den Boer, Bart P C van de Warrenburg, Vivian Weerdesteyn, Alexander C Geurts
• Journal: Journal of rehabilitation medicine (J Rehabil Med) Vol. 51 Issue 6 Pg. 434-441 (Jun 18 2019) ISSN: 1651-2081 [Electronic] Sweden
• PMID: 30968942 (Publication Type: Journal Article)

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Adult
• Aged
• Botulinum Toxins, Type A (administration & dosage)
• Combined Modality Therapy
• Female
• Gait (physiology)
• Hip (physiopathology)
• Humans
• Male
• Middle Aged
• Muscle Stretching Exercises (methods)
• Neuromuscular Agents (administration & dosage)
• Spastic Paraplegia, Hereditary (physiopathology, therapy)
• Treatment Outcome