Effectiveness of Early Botulinum Toxin Injections on Upper Limb Spasticity versus after 6 months post stroke

Abstract

Background
Stroke is nominated as the third-leading cause of disability across the world. Spasticity may evolve early in the post-stroke period, with the majority of stroke survivors experiencing hand impairment that greatly affects their global function. This work aimed to determine the effect of Botulinum toxin type A (BoNT-A) injection on upper limb spasticity in post-stroke patients and to compare the effect of early BoNT-A injection with that of injection after 6 months post-stroke on upper limb spasticity and functional scores.


Methods
This interventional study was conducted on 60 patients diagnosed with post- stroke upper-limb spasticity affecting their dominant side. The degree of spasticity was determined using the Modified Ashworth scale. The Shah Modified Barthel Index was used to assess functional status. Upper limb motor function was further examined using the Upper Limb subscale of the Motor Assessment Scale (UL-MAS), and disability level was evaluated using the Four-Point Disability Scale. All patients were assessed pre- and four weeks post-injection. Patients who received Botulinum injection within 3 months post- stroke were classified as Early Group 1 and those who acquired injection 6 months post stroke as Late Group 2. Following the injection, all patients received a rehabilitation program. Progress towards individualized pretreatment goals was assessed using the Goal Attainment Scale. Global evaluation of improvement was conducted using the physician, patient, and caregiver global assessments.


Results

Modified Ashworth and disability assessment scale were significantly lower, while Upper Limb Motor assessment scale and Barthel index were significantly higher post- injection in both groups (P < 0.001). Group I showed significant improvement of all scales post- injection compared to Group II (P < 0.05). Group I had a higher statistically significant improvement in Patients’, Physician’s, and Caregiver’s global assessments (PGA)(PhGA)(CGA) as well as the Goal attainment scale (GAS), than Group 2. Stroke duration was positively correlated with post- injection spasticity and disability scores, while showed negative correlation with the Upper Limb Motor assessment scale (
P
 < 0.001).



Conclusions
The early and late injection groups showed clinical improvements following Botulinum toxin treatment. However, early administration within three months post-stroke results in better outcomes.