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Case report

Benefit and safety of incobotulinumtoxina for early management of post-stroke spasticity in a patient with SARS-CoV-2: A case report

Carlos Cordero-García, María del Mar Sáenz de Tejada Sánchez
Physical Medicine and Rehabilitation, Juan Ramón Jiménez University Hospital, Huelva, Spain
DOI: 10.2340/20030711-1000065

Abstract

Objective: To describe a case of early management of post-stroke spasticity treated with incobotulinumtoxinA (IncoA) in a patient with SARS-CoV-2 (COVID-19). Scarce information is available on this subject, as the COVID-19 pandemic has necessitat-ed postponement of interventions in infected and clinically suspicious patients.
Case report: A 58-year-old woman presenting with ischaemic stroke, was infected with SARS-CoV-2 virus due to nosocomial contact. Despite clinical improvement, the patient developed early spasticity. Modified Ashworth Scale (MAS) was grade II in her left elbow, wrist flexors and left gastrocnemius. IncoA was injected, using ultrasound guidance, in her upper and lower limbs. No complications were reported after the procedure. Two weeks after-wards, there was an improvement in her motor balance and spasticity, MAS was graded I in the left elbow, wrist flexors, and II in the left gastrocnemius. At 12 weeks, the patient reported improvement at a global level, with increasing independence and functionality.
Conclusion: This case indicates the benefits and safety of IncoA for early treatment of post-stroke spasticity in a patient with confirmed SARS-CoV-2. Despite the current status of national healthcare systems due to the COVID-19 pandemic, increased efforts should be made to avoid discontinuation of treatment for spasticity.

Lay Abstract

One-third of patients with stroke develop spasticity, which induces stiffness, fibrosis, and atrophy. In early management of stroke it is important to minimize these consequences. However, the COVID-19 pandemic has resulted in the postponement of interventions in infected and clinically suspicious patients. We report here a case of a patient who was infected with SARS-CoV-2 virus while staying in hospital after a stroke and developed early spasticity. We report the patient’s recovery, including treatment with incobotulinumtoxinA for spasticity. The relevance for clinical practice is that the early treatment of post-stroke spasticity with incobotulinumtoxinA was effective, with a favourable safety profile, in this patient with SARS-CoV-2 infection. Despite the current status of national healthcare systems due to the COVID-19 pandemic, greater efforts should be made to avoid the discontinuation of treatment for spasticity.

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