Cortical activation changes in patients suffering from post-stroke arm spasticity and treated with botulinum toxin a
Language English Country United States Media print-electronic
Document type Case Reports, Journal Article, Research Support, Non-U.S. Gov't
- Keywords
- Stroke, arm spasticity, botulinum toxin, finger movement, functional magnetic resonance imaging,
- MeSH
- Botulinum Toxins, Type A therapeutic use MeSH
- Stroke complications drug therapy physiopathology MeSH
- Evoked Potentials * MeSH
- Middle Aged MeSH
- Humans MeSH
- Neuromuscular Agents therapeutic use MeSH
- Arm MeSH
- Movement MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Sensorimotor Cortex drug effects physiopathology MeSH
- Muscle Spasticity drug therapy etiology physiopathology MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Botulinum Toxins, Type A MeSH
- Neuromuscular Agents MeSH
BACKGROUND AND PURPOSE: Botulinum toxin (BoNT) treatment relieves focal arm spasticity after stroke, likely acting at several hierarchical levels of the motor system. The central correlate of BoNT-induced spasticity relief may be detected using repeated functional MRI (fMRI) during motor task. METHODS: Five patients (4 males, 1 female, mean age 67 years) with hemiparesis and distal arm spasticity after chronic ischemic stroke were studied. FMRI was performed while moving the paretic hand in three sessions: before and 4 and 11 weeks after BoNT treatment. RESULTS: Arm spasticity significantly decreased following BoNT treatment across the group (mean modified Ashworth scale change .6). FMRI prior to BoNT treatment showed extensive bilateral active networks, whereas post-BoNT activation was limited to midline and contralateral sensorimotor cortices, and the third examination, when the toxin effect has worn off, again showed extensive activation similar to pre-BoNT examination. Post-BoNT session 2 compared to sessions 1 and 3 demonstrated a significantly less activation in contralateral frontoparietal areas including inferior frontal, postcentral, and middle frontal gyri as well as transient crossed cerebellar activation. CONCLUSION: Relief of post-stroke arm spasticity may be associated with changes at several hierarchical levels of the cortical sensorimotor system, including the prefrontal cortex.
References provided by Crossref.org
The Central Effects of Botulinum Toxin in Dystonia and Spasticity
