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Botulinum toxin in severe upper extremity spasticity among patients with traumatic brain injury

An open-labeled trial

From The Brain Injury Program (Drs. Yablon, Ivanhoe, and Boake), The Institute for Rehabilitation and Research, Houston, TX; the Department of Physical Medicine and Rehabilitation (Drs. Yablon, Ivanhoe, and Boake), University of Texas Health Science Center-Houston, Houston, TX; and the Department of Physical Medicine and Rehabilitation (Drs. Yablon, Agana, and Ivanhoe), Baylor College of Medicine, Houston, TX.
Received January 18, 1995. Accepted January 24, 1996.
Address correspondence and reprint requests to Dr Yablon, The Brain Injury Program, Mississippi Methodist Rehabilitation Center, 1350 East Woodrow Wilson, Jackson, MS 39216-5112.

We studied the effect of botulinum toxin A (BTXA) among patients with traumatic brain injury (TBI) and severe spasticity unresponsive to conservative management.Twenty-one consecutive adult patients with severe spasticity involving the wrist and finger flexor musculature were treated with BTXA injection (20 to 40 units per muscle) under EMG guidance. After injection, patients received passive range of motion (ROM) exercise, with modalities and casting as clinically indicated. Outcome measures, including wrist ROM and the modified Ashworth Scale (MAS), were assessed 2 to 4 weeks after injection. Among the respective acute and chronic groups, mean ROM improved 42.9 (p = 0.001) and 36.2 degrees (p < 0.001). Mean MAS rating improved 1.5 (p = 0.01) and 1.47 (p = 0.002) points. There were no significant adverse effects. BTXA, in conjunction with conventional modalities, significantly improves spasticity and ROM in the distal upper extremity musculature of patients with TBI.

NEUROLOGY 1996;47: 939-944

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