The Effect of Repeated abobotulinumtoxinA (Dysport®) Injections on Walking Velocity in Persons with Spastic Hemiparesis Caused by Stroke or Traumatic Brain Injury.

Walking velocity was not the primary endpoint of the underlying double-blind or open-label studies, and the ambulatory-category and repeated-measures analyses were post hoc rather than planned. The repeated-injection analysis compared Week 12 results with baseline in an open-label extension, not with a concurrent placebo group, so the observed gains cannot be separated from time, practice, or other changes during the study. Patients received variable treatment: injections were given to the gastrocnemius-soleus complex and, by investigator judgment, to other lower-limb muscles and sometimes the upper limb, and approximately 60% received concomitant physiotherapy, so the contribution of any single component cannot be separated. Patients with baseline comfortable barefoot walking speed above 0.8 m/s were excluded, so the results do not apply to people already walking at unlimited community ambulation speed. Not all patients completed every assessment at Week 12, and the fifth injection cycle was excluded because Week 12 data were not available, so the analyzed sample varied by test and cycle. The open-label phase was unblinded, so patients and investigators knew active treatment was being given during the repeat cycles.

Do not read these gains as proof that repeated Dysport injections alone improve walking. Walking was not the primary endpoint, the repeated-injection analysis was open-label and compared with baseline rather than placebo, and patients could also receive physiotherapy or upper-limb injections, so the effect of any single component cannot be separated. Also, only 17% of comfortable barefoot walkers reached the unlimited community ambulation threshold after four injections.