ROLE OF EARLY BOTULINUM TOXIN TYPE A INJECTION IN THE TREATMENT OF PATIENTS WITH POSTSTROKE SPASTICITY: PRELIMINARY RESULTS OF AN OBSERVATIONAL STUDY

Introduction: Botulinum toxin type A (BoNT-A) has proven to be safe and effective in the treatment of poststroke spasticity (PSS).1 To date, there is encouraging evidence regarding BoNT-A as an early intervention for PSS.2 However, its use remains outside usual daily practice. Thus, the aim of this observational multicenter study was to evaluate the role of early BoNT-A injection in the management of PSS in adults. Methods: Inclusion criteria: muscle tone !1+ and <4 on the Modified Ashworth Scale (MAS) at the affected limbs, time from stroke <12 months, and no previous BoNT-A treatment. Baseline assessment was made at the injection visit. BoNT-A dose was adjusted per targeted muscle, depending on the level of spasticity and the clinical presentation. The MAS (primary outcome), Motricity Index, Fugl-Meyer assessment, and Modified Rankin Scale scores were evaluated at 4 (T1), 12 (T2), and 24 (T3) weeks after BoNT-A injection. Results: Between June 2015 and August 2018, 84 patients were recruited. Here we present preliminary analysis involving 59 patients (22 females, 37 males; mean age, 64.9 years) with PSS (mean time from onset, 127.8 days). Thirty-three patients were injected with abobotulinumtoxinA, 15 patients were injected with onabotulinumtoxinA and 11 patients were injected with incobotulinumtoxinA. For the primary outcome, we found that time between stroke onset and BoNT-A injection was directly associated (Spearman correlation) with the MAS score of the following muscles: elbow flexors at T1 (P1⁄40.046) and T2 (P1⁄40.020); forearm pronators at T2 (P1⁄40.021) and T3 (P1⁄40.031); wrist flexors at T1 (P1⁄40.019) and T2 (P1⁄40.043); finger flexors at T1 (P1⁄40.001) and T2 (P1⁄40.003); thumb flexors at T1 (P1⁄40.017); and ankle plantar flexors at T1 (P1⁄40.020) and T2 (P1⁄40.020). Conclusions: Our preliminary results support the hypothesis that early treatment of PSS with BoNT-A may lead to lower levels of muscle hyper- tonia up to 1, 3, and 6 months after injection.