Botulinum Treatment for Post-stroke Spasticity: Low Dose Regime
ADULYA VIRIYAVEJAKUL, M.D., F.R.C.P.*, ROONGTIWA VACHALATHITI, Ph.D.**, NIPHON POUNGV ARIN, M.D., F.R.C.P. *
Affiliation : * Department of Medicine, ** School of Physiotherapy, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Abstract
The purpose of this study was to investigate the effects of botulinum A toxin for the
treatment of post-stroke spasticity patients. Twenty two post-stroke spas-ticity patients were
recruited in the study. All patients had moderate to severe spasticity of upper and lower extre-
mities. Botulinum toxin was injected intramuscularly according to the spasticity pattern. Injec-
tions were performed at either 2, 3, or 6 month intervals as determined by the neurologist. The
total dose of each session of injection varied between 50-100 IU. Subjective and objective
examinations were conducted by the physiotherapist prior to the first injection and sub-
sequently at 1st week, 2nd week and every month after each injection. All patients were asked
subjectively about their satisfaction with the treatment. The objective examinations used in this
study were Ashworth scale and Fugl-Meyer Sensorimotor Assessment Form. All patients were
satisfied with the treatment. Marked reduction of the spasticity was found after one to two
weeks of injection. The duration of effectiveness of botulinum toxin for spasticity is from 3-6
months. The average improvement in Ashworth score was between 1 and 1.5 points. The
Fugl-Meyer scores showed significant improvement in most patients for the motor function of
upper and lower extremities, and balance. All patients demonstrated increase in passive range
of joint motion and decrease in joint pain.
This study demonstrates that botulinum toxin therapy is safe and effective in treating
chronic upper and lower extremities' spasticity following stroke. The dosage used in this
study is about one-half of the recommended dosage in the literature. The only drawback of this
therapy is its high cost (300 US dollars for 100 I.U.).
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