Can the early use of botulinum toxin in post stroke spasticity reduce contracture development? A randomised controlled trial.
Cameron Lindsay, Sissi Ispoglou, Brinton Helliwell and 3 others
PMID 33040610WHAT IT FOUND
Early botulinum toxin injections reduced spasticity and slowed elbow contracture formation in stroke patients.
All participants also received electrical stimulation. While the treatment did not improve arm function scores, it significantly reduced the need for splints at three and six months post-stroke.
Key findings
01Botulinum toxin injections reduced elbow spasticity and slowed the rate of passive range loss compared to placebo.
02Patients receiving botulinum toxin required significantly fewer splints at three and six months post-stroke.
03There was no significant difference in arm function recovery between the treatment and placebo groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
All patients received electrical stimulation, making it impossible to separate the effects of the toxin from the stimulation. Some patients had already developed spasticity before randomisation due to consent delays, potentially reducing the 'early' treatment effect. The study was powered for function but reported null functional outcomes; the reduction in splinting was a secondary finding. The trial was single-centre and Phase II, requiring confirmation in a larger multi-centre trial.
Declared interests
The drug was provided by Allergan, which also gave an unrestricted educational grant. Authors CL, ADP, SS, and DH received honoraria or funding from Allergan, Ipsen, and Merz. Allergan had no role in study design, data collection, analysis, or writing.
The easy way to misread this
Do not attribute the reduction in splinting solely to botulinum toxin. Every patient in this trial also received cyclical electrical stimulation for 90 days, so the benefit may result from the combination of treatments rather than the injections alone.