ArticleFrontiers in neurology
Comparing the real-world effectiveness of botulinum toxin type A injections across distinct poststroke muscle hyper-resistance patterns.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
9 authors.
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Abstract
Background: Post-stroke muscle hyper-resistance is produced by both neurogenic (spasticity) and non-neurogenic (contracture) factors. BoNT-A is the most effective intervention for post-stroke spasticity, yet whether concomitant contracture alters its therapeutic benefit remains unclear. Aims: To compare BoNT-A effectiveness in plantar-flexor hyper-resistance stratified by contracture. Methods: We retrospectively reviewed stroke survivors with spastic hemiplegia and ankle plantar-flexor hyper-resistance who received BoNT-A injections. Patients were stratified into two groups according to the presence of restricted passive ankle dorsiflexion: the spasticity group (PROM limitation <7°) and the spasticity-with-contracture group (PROM limitation ≥7°). Outcomes were assessed at baseline and at 2, 4 and 12 weeks post-injection, including the Modified Ashworth Scale (MAS) for plantar-flexors, Brunnstrom Recovery Stage (BRS), Fugl-Meyer Assessment (FMA) lower-extremity subscore and Barthel Index (BI). Results: A total of 107 patients were enrolled-54 in the spasticity group and 53 in the spasticity-with-contracture group. Baseline comparison revealed a significantly longer disease duration in the spasticity-with-contracture group; other characteristics were comparable. Both groups achieved improvements in MAS and BRS at all three follow-up visits. FMA and BI improved in the spasticity group at 4 and 12 weeks, whereas the spasticity-with-contracture group showed improvement only at 12 weeks. Between-group analyses indicated that MAS and BRS scores were consistently better in the spasticity group at each time point; although median FMA and BI were numerically higher in this group, the differences did not reach statistical significance. Conclusion: BoNT-A markedly reduces post-stroke hyper-resistance and enhances motor function and activities of daily living; by contrast, concomitant contracture is associated with delayed and attenuated improvement in MAS and BRS.
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