Post-stroke spasticity: follow-up and functional implications of chronic long-term treatment with botulinum toxin.
Marco Battaglia, Margherita B Borg, Alberto Loro and 9 others
PMID 38888735WHAT IT FOUND
Over four years, 36 chronic stroke survivors receiving botulinum toxin and rehabilitation showed stable improvements in balance and fall risk (TUG).
However, gains in walking endurance and speed declined over time, with fewer patients reaching clinically meaningful thresholds in later cycles.
Key findings
01The number of patients achieving clinically significant improvement in walking endurance (6MWT) dropped from 11 to 5, and in walking speed (10mWT) from 6 to 1, between the first and last treatment cycles.
02Improvements in balance and agility (TUG) remained stable over the four years, with 9-10 patients consistently showing clinically significant change after the initial cycle.
03Patients with lower walking independence (FAC ≤ 3) were more likely to improve on the TUG, while those with higher independence (FAC > 3) were more likely to improve on endurance and speed tests.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study is retrospective and observational, lacking a control group, so it cannot prove that botulinum toxin or the specific rehabilitation protocol caused the observed functional changes. The sample size was small (36 patients), and the participants were heterogeneous in disability severity and specific treatment details. The study excluded patients who could not walk before the stroke or those with severe cognitive impairment, limiting generalizability to more dependent populations. Spasticity was measured using the Modified Ashworth Scale, which has known limitations, though it was the standard in the medical records analyzed.
Declared interests
The authors declare no conflicts of interest with any financial organization regarding the material discussed in the manuscript.
The easy way to misread this
Do not interpret the stable TUG improvements as evidence that botulinum toxin alone maintains function. The authors explicitly state that the results reflect a multimodal approach where rehabilitation exploits the window of reduced spasticity; the contribution of the injection versus the therapy cannot be separated.