Journal of Rehabilitation Medicine 51-10 | Page 93

J Rehabil Med 2019; 51: 813–816 SHORT COMMUNICATION EFFECTS ON WALKING OF SIMULTANEOUS UPPER/LOWER LIMB ABOBOTULINUMTOXINA INJECTIONS IN PATIENTS WITH STROKE OR BRAIN INJURY WITH SPASTIC HEMIPARESIS* Peter J. MCALLISTER, MD 1 , Svetlana E. KHATKOVA, MD 2 , Steven G. FAUX, FAFRM (RACP) 3,4 , Philippe PICAUT, PharmD 5 , Romain RAYMOND, MSc 6 and Jean-Michel GRACIES, MD, PhD 7 From the 1 New England Institute for Neurology and Headache, Stamford, CT, USA, 2 Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia, 3 St Vincent’s Hospital, New South Wales, Australia, 4 University of New South Wales, New South Wales, Australia, 5 Ipsen Pharma, Les Ulis, France, 6 Ividata, Levallois-Perret, France, and 7 EA 7377 BIOTN, Université Paris-Est, Hospital Albert Chenevier-Henri Mondor, Department of Neurorehabilitation, Créteil, France Objective: To compare walking speed in patients with spastic hemiparesis who received abobotuli- numtoxinA either in the lower limb or simultaneous- ly in both the lower and upper limbs. Design: Post hoc analysis from a phase 3 study of abobotulinumtoxinA (Dysport®, NCT01251367). Patients: Adult patients with spastic hemiparesis causing gait dysfunction. Methods: Comfortable barefoot walking speed over 10 m was evaluated in 127 patients receiving lo- wer limb vs lower and upper limb injections over ≤4 treat­ment cycles; 1,000 U or 1,500 U in lower limb for cycle 1/2; optional upper limb injections from cy- cle 3 (500 U: upper limb, 1,000 U: lower limb). Results: Mean (standard deviation; SD) lower limb cycle 3/4 doses were lower in the lower plus up- per limb group vs lower limb only (1,000 U (SD 50), 1,000 U (SD 50) vs 1,380 U (SD 210), 1,360 U (SD 220). Baseline comfortable barefoot walking speed was similar between groups. Changes at cycle 3 week 4, in m/s, were: lower and upper limb: +0.063 (SD 0.131); lower limb only: +0.078 (SD 0.114), and cycle 4 week 4: lower and upper limb: +0.086 (SD 0.166); lower limb only: +0.086 (SD 0.123). Conclusion: Simultaneous lower and upper limb abobotulinumtoxinA treatment does not hamper im- provement in walking speed compared with lower limb treatment alone. Thus, physicians may split the 1,500 U abobotulinumtoxinA dose as needed to best treat patients with spastic paresis. Key words: muscle spasticity; paresis; botulinum toxin, type A; walking speed, stroke, traumatic brain injury. Accepted Sep 4, 2019; Epub ahead of print Sep 17, 2019 J Rehabil Med 2019; 51: 813–816 Correspondence address: Peter J. McAllister, New England Institute for Neurology and Headache, 30 Buxton Farm Road, Ste. 230, Stamford, CT 06905, USA. E-mail: [email protected] S pastic hemiparesis can result from stroke and often involves both the lower (LL) and upper limb (UL) *This work was presented in part as a poster at the American Academy of Physical Medicine and Rehabilitation in Denver, CO, USA, 12–15 October 2017, and as an oral presentation at the 10th World Congress for Neurorehabilitation in Powai, Mumbai, India, 7–10 February 2018. LAY ABSTRACT Spastic hemiparesis is a condition in which the mus- cles on one side of the body become weak and stiff, often after a stroke. One treatment involves injecting botulinum toxin (e.g. abobotulinumtoxinA) into the af- fected muscles. Patients may find walking difficult, but repeated injections of abobotulinumtoxinA into the legs have been associated with improved walking speed. How­ever, it is not known whether improvements in walking speed are maintained when the dose of abobo- tulinumtoxinA is split to treat other affected areas, such as the arms. This study shows that splitting the dose of abobotulinumtoxinA across the arms and legs does not hamper walking speed, compared with injecting into the legs only. This suggests that doctors can split the dose across the arms and legs as needed to best treat the symptoms of spastic hemiparesis. (1). Up to 75% of stroke survivors depend on caregi- vers for activities of daily living, and impaired gait contributes to decreased independence (2). In a global survey of patients living with spasticity, 72% and 44% of respondents reported decreased quality of life and a loss of independence, respectively (2). Improvement in walking is a common goal for patients, with walking speed shown to be a predictor for reintegration into the community and increased probability of survival (3, 4). Management of spastic paresis often requires treat- ment of both the LL and UL. However, limited data are available regarding their simultaneous treatment with botulinum neurotoxin type A (BoNT-A), which is known to improve symptoms in spastic paresis. BoNT-A treatment of the UL may impact on walking ability by improving trunk control and posture (5). In preliminary studies, improved gait and faster walking speed were observed in patients with hemiparesis following stroke and in children with cerebral palsy, following BoNT-A treatment of the affected UL (5–7). AbobotulinumtoxinA (Dysport®, aboBoNT-A) has proven efficacious in the treatment of both LL and UL spasticity when injected separately (8, 9). Repeated aboBoNT-A injections into the LL or UL have been associated with improvement in both active movement and function, with increased walking speed observed following repeated LL injections (10, 11). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2604