Content » Vol 47, Issue 2

Original report

Functional effects of botulinum toxin type-A treatment and subsequent stretching of spastic calf muscles: A study in patients with hereditary spastic paraplegia

Mark de Niet, Susanne T. de Bot, Bart P.C. van de Warrenburg , Vivian Weerdesteyn, Alexander C. Geurts
Department of Rehabilitation, Centre for Evidence Based Practice and Donders Institute for Brain, Cognition, and Behaviour, Radboud, Radboud University Medical Centre, The Netherlands
DOI: 10.2340/16501977-1909

Abstract

Objective: Although calf muscle spasticity is often treated with botulinum toxin type-A, the effects on balance and gait are ambiguous. Hereditary spastic paraplegia is characterized by progressive spasticity and relatively mild muscle weakness of the lower limbs. It is therefore a good model to evaluate the functional effects of botulinum toxin type-A.
Design: Explorative pre-post intervention study.
Subjects: Fifteen subjects with pure hereditary spastic paraplegia.
Methods: Patients with symptomatic calf muscle spasticity and preserved calf muscle strength received botulinum toxin type-A injections in each triceps surae (Dysport®, 500–750 MU) followed by daily stretching exercises (18 weeks). Before intervention (T0), and 4 (T1) and 18 (T2) weeks thereafter, gait, balance, motor selectivity, calf muscle tone and strength were tested.
Results: Mean comfortable gait velocity increased from T0 (0.90 m/s (standard deviation (SD) 0.18)) to T1 (0.98 m/s (SD 0.20)), which effect persisted at T2, whereas balance and other functional measures remained unchanged. Calf muscle tone declined from T0 (median 2; range 1–2) to T1 (median 0; range 0–1), which effect partially persisted at T2 (median 1; range 0–2). Calf muscle strength did not change.
Conclusion: Botulinum toxin type-A treatment and subsequent muscle stretching of the calves improved comfortable gait velocity and reduced muscle tone in patients with hereditary spastic paraplegia, while preserving muscle strength. Balance remained unaffected.

Lay Abstract

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