If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  ANA: Simple Techniques Increase Effectiveness of Botulin Toxin in Controlling Upper Limb Spasticity By Thomas S. May Special to DG News New York, NY -- October 16, 2002 -- In a groundbreaking study, researchers reported that both high-volume dilution of botulinum toxin-A (Botox) and an endplate targeting technique provide greater neuromuscular block and spasticity reduction than a low-volume dilution in the treatment of upper limb plasticity. Dr. Jean-Michel Gracies, clerkship director and an assistant professor in the neurology department of Mount Sinai Medical Center, in New York, United States, presented the findings here October 15 at the 127th annual meeting of the American Neurological Association (ANA). Twenty-one adult hemiparetic patients were enrolled in a randomised, double blind trial. Because animal data suggest that high dilution and endplate-targeted injections of botulinum toxin-A increase botulinum-induced muscle paralysis, the researchers hypothesized that these techniques might improve the drug’s effectiveness in controlling muscle spacticity. During the course of the experiment, 160 units of botulinum toxin-A were injected into four sites of biceps brachii in three groups of patients. The first group received injections of 100MU/mL dilution (0.4mL/site) using a 4-quadrant technique. The second group was injected using 100MU/mL dilution (0.4mL/site) an endplate-targeting technique, and the third group received 20MU/mL dilution (2mL/site), with 4-quadrant technique. The researchers measured the mean rectified voltage during isometric elbow flexor maximal voluntary contraction, elbow flexor spasticity angle (Tardieu scale), and elbow flexor maximal voluntary contraction (strain gauge). Baseline measures were comparable in the three groups. Changes in spasticity angle in the group injected using the endplate-targeting technique (group 2) and in the group injected using high-volume dilution (group 3) were significantly different from the changes observed in group 1 (p<0.05). The investigators concluded that a high-volume dilution of botulinum toxin-A -A or an endplate-targeting technique provide greater neuromuscular block and spasticity reduction than a low-volume dilution in the spastic biceps brachii. "This was the first controlled, double-blind study comparing two dilutions in the use of Botox in spasticity," said Dr. Gracies. "Proving that a simple injection technique, such as increased dilution, produces increased effects for the same dose -- and at the same cost -- has both practical and economic advantages," said Dr. Gracies. The study was funded by Allergan, Inc., the manufacturer of Botox.
|
