The Pharmaceutical Journal
Vol 269 No 7211 p206
17 August 2002

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New England Journal of Medicine (content.nejm.org)

Botulinum toxin reduces spasticity after stroke

Injections of botulinum toxin A (Botox) can reduce spasticity of muscles and associated disability in stroke patients, a double-blind randomised controlled trial has shown (New England Journal of Medicine 2002;347:395).

American researchers compared the safety and efficacy of a one-off injection of botulinum toxin A (200–240 units) with placebo in 126 people who had increased flexor tone in their wrist and fingers following a stroke. Almost two-thirds of patients (62 per cent) injected with botulinum toxin A reported improvements of at least one point on the Disability Assessment Scale after six weeks, compared with only 27 per cent of the placebo group.

Self-reported disability related to hygiene, dressing, pain and limb position, and patients selected one area where they experienced moderate to severe disability as the principal treatment target. The botulinum toxin A group reported greater improvements in principal target areas than the placebo group over the duration of the 12-week study.

Furthermore, patients injected with the toxin suffered no major adverse effects, and prevalence of minor adverse events such as headache was similar in both groups.

The researchers conclude that a one-off botulinum toxin A injection into the spastic muscles could improve flexor tone, functional disability and quality of life in patients suffering post-stroke spasticity of the fingers and wrist.