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To better understand the site of action of Botulinum Toxin (BTX) in spasticity, we studied 6 patients affected with upper limb post-stroke spasticity. Patients were injected with Botulinum Toxin type A (Botox ® , Allergan SpA, Rome, Italy) in one or more arm muscles with total doses not to exceed 200 U (mean 158 U). Mean onset of stroke was 22 months. Tests before injection, 15 days and 30 days after included: (i) evaluation of tone (Ashworth score); (ii) active and passive range of motion at elbow and wrist; (iii) ratio Hmax/Mmax from flexor carpi radialis (FCR); (iv) H-reflex presynaptic inhibition during vibration (FCR); (v) functional score; (vi) reciprocal inhibition of the H-reflex (FCR); (vii) kinesiologic EMG. The clinical examination improved in all patients, and changes of the functional and Ashworth scores were significant ( p The results suggest that the use of BTX in patients affected with spasticity does not act at the level of changes in presynaptic inhibition of alpha-motoneurons. |
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