Trends in spasticity-reducing surgery and botulinum toxin treatment for post-stroke spasticity: a register study on 6,258 patients in Sweden, 2010-2021.
Marcus Sagerfors, Izabela Blaszczyk, Anette Chemnitz and 2 others
PMID 40099827WHAT IT FOUND
Patients who had surgery received fewer botulinum toxin injections afterward, but the registry could not show surgery caused this.
Surgery use stayed flat while injection use rose.
Key findings
01The register included 110,419 visits by 6,258 patients, all with a diagnosis of stroke or late effects of cerebrovascular disease.
02Among 865 patients who had surgery and botulinum toxin before and after surgery, recorded botulinum toxin injections were 0.9 per year after surgery and 1.5 per year before surgery.
03Spasticity-reducing surgery use did not increase over time, while botulinum toxin treatments rose from almost 2,000 per year in 2010 to 5,000 in 2021.
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
The study was not randomised, so the lower injection count after surgery cannot be treated as a proven treatment effect. No patient-reported outcome measures were available, so function, pain, hygiene, or walking benefits were not measured in this cohort. The registry did not record which types of tenotomy or tendon lengthening were performed, or the exact level of neurectomy. The cohort mean age was 58, while the paper reports mean ages of 74 for men and 75 for women living with stroke in Sweden, so findings may not apply to older patients. Regional differences in surgery rates were reported, but the study did not show why they occurred. The authors state that no causative association can be established from these registry data.
Declared interests
The authors have no conflicts of interest to declare. The study was funded by grants from Promobilia, IPSEN, and the Agneta Prytz-Folkes and Gösta Folkes Foundation.
The easy way to misread this
Do not read the lower injection count after surgery as proof that surgery reduces spasticity or improves function. The study had no randomisation and no patient-reported outcomes, and the authors state that no causative association can be established.