This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hesse, S. Articles by Mauritz, K.H. Search for Related Content PubMed PubMed Citation Articles by Hesse, S. Articles by Mauritz, K.H.

(Stroke. 1996;27:455-460.)
© 1996 American Heart Association, Inc.

Articles

Ankle Muscle Activity Before and After Botulinum Toxin Therapy for Lower Limb Extensor Spasticity in Chronic Hemiparetic Patients

S. Hesse, MD; J. Krajnik, MS; D. Luecke, PT; M.T. Jahnke, MD; M. Gregoric, MD K.H. Mauritz, MD

From the Klinik Berlin, Department of Neurological Rehabilitation, Free University Berlin (Germany) (S.H., D.L., M.T.J., K.H.M.), and the Rehabilitation Institute, Ljubljana, Slovenia (J.K., M.G.).

Correspondence to Stefan Hesse, MD, Klinik Berlin, Kladower Damm 223, 14089 Berlin, Germany.

Background and Purpose Recent studies have been made of the novel treatment of lower limb spasticity after stroke with botulinum toxin A, and the results were based mostly on the clinical assessment made before and after treatment. This study investigated the effects of the toxin on ankle muscle activity during gait in patients with severe extensor spasticity. The questions posed were whether the toxin particularly diminishes the so-called premature muscle activity as a major cause of equinovarus deformity and whether different types of altered motor control allow a prediction of the outcome of the treatment.

Methods In 12 chronic hemiparetic outpatients with pronounced lower limb spasticity, we injected 400 U botulinum toxin A into the soleus and tibialis posterior muscles and both heads of the gastrocnemius muscles. Ankle spasticity and complex gait analysis including kinematic electromyography (EMG) of the soleus and tibialis muscles were assessed before treatment and 4 weeks after the injection.

Results Nine patients profited with a reduction of spasticity, improved gait ability, and a more normal temporal pattern of muscle activity with a prominent reduction of the premature activity of the plantar flexors. Eight patients exhibited a qualitative pattern (type I) corresponding to an increased stretch-reflex excitability. Three patients did not profit: their muscle tone, gait ability, and muscle activation remained stable or even deteriorated.

Conclusions This study further supports the beneficial effects of botulinum toxin in the treatment of lower limb extensor spasticity. A correlation was observed between the clinical reduction of muscle tone, functional gait parameters, and a more normal EMG pattern with a predominant reduction of the premature activity of the plantar flexors. The qualitative type of EMG pattern corresponding to an increased stretch-reflex excitability (type I) was a positive predictor for the outcome.

Key Words: botulinum toxins • gait • hemiplegia • muscle spasticity • rehabilitation

This article has been cited by other articles:

				S. Ozcakir and K. Sivrioglu Botulinum Toxin in Poststroke Spasticity Clin. Med. Res., June 1, 2007; 5(2): 132 - 138. [Abstract] [Full Text] [PDF]

				E. S. Park, C. I. Park, H. C. Chang, C. W. Park, and D. S. Lee The effect of botulinum toxin type A injection into the gastrocnemius muscle on sit-to-stand transfer in children with spastic diplegic cerebral palsy Clinical Rehabilitation, August 1, 2006; 20(8): 668 - 674. [Abstract] [PDF]

				R. J. Woods, R. L. Cervone, and H. H. Fernandez Common Neurologic Disorders Affecting the Foot J Am Podiatr Med Assoc, March 1, 2004; 94(2): 104 - 117. [Abstract] [Full Text] [PDF]

				W. M. Landau and S. A. Sahrmann Preservation of Directly Stimulated Muscle Strength in Hemiplegia Due to Stroke Arch Neurol, September 1, 2002; 59(9): 1453 - 1457. [Abstract] [Full Text] [PDF]

				D. A. Gelber and P. B. Jozefczyk Therapeutics in the Management of Spasticity Neurorehabil Neural Repair, March 1, 1999; 13(1): 5 - 14. [Abstract] [PDF]

				L. Ada, W. Vattanasilp, N. J O'Dwyer, and J. Crosbie Does spasticity contribute to walking dysfunction after stroke? J. Neurol. Neurosurg. Psychiatry, May 1, 1998; 64(5): 628 - 635. [Abstract] [Full Text] [PDF]

				D. Richardson, S. Edwards, G. Sheean, R. Greenwood, and A. Thompson The effect of botulinum toxin on hand function after incomplete spinal cord injury at the level of C5/6: a case report Clinical Rehabilitation, November 1, 1997; 11(4): 288 - 292. [Abstract] [PDF]

				S. Hesse, B. Helm, J. Krajnik, M. Gregoric, and K.H. Mauritz Treadmill Training with Partial Body Weight Support: Influence of Body Weight Release on the Gait of Hemiparetic Patients Neurorehabil Neural Repair, January 1, 1997; 11(1): 15 - 20. [Abstract] [PDF]