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Management of spasticity with botulinum toxin type A: implementing the treatment algorithm
Author(s) -
O'Brien Christopher
Publication year - 1999
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.1999.tb00040.x
Subject(s) - spasticity , medicine , botulinum toxin , physical medicine and rehabilitation , psychological intervention , physical therapy , surgery , psychiatry
Intramuscular injections of botulinum toxin type A (BTX‐A) may successfully treat spasticity resulting from focal muscle overactivity. However, BTX‐A should not be considered as a monotherapy. Physical interventions such as strengthening programmes, range‐of‐motion exercises or serial casting should be implemented following BTX‐A injections. The likelihood of treatment success relies heavily on tailoring the treatment protocol to an individual's needs. This paper presents five case studies which describe patient management problems that have been addressed by applying an algorithm for the management of spasticity with botulinum toxin type A. The case studies are representative of patients with hand, arm, hip, leg and/or foot spasticity who have received BTX‐A injections. The potential pitfalls of BTX‐A treatment are presented and possible reasons for treatment failure are discussed. The case studies highlight the importance of reassessing functional objectives for each individual after treatment. The objectives of BTX‐A treatment vary considerably between patients. If the treatment goals are not achieved, modification of the injection procedure and/or dose may be required. A continued failure of treatment suggests either poor patient selection or inappropriate treatment goals. Successful treatment does not obviate the need for routine re‐evaluation of the goals at treatment follow‐up.