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ISSN: 1641-4640
Folia Neuropathologica
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vol. 61
Original paper

Botulinum neurotoxin-A in a patient with post-stroke spasticity: a neurophysiological study

Safa Muntadher Fawzi
Farqad Bader Hamdan
Israa F. Jaafar
Gheyath Abd Ali Shallal Al Gawwam

Department of Physiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
Department of Dentistry, Al-Esraa University College, Baghdad, Iraq
Department of Medicine, College of Medicine, Baghdad University, Baghdad, Iraq
Folia Neuropathol 2023; 61 (4): 412-418
Online publish date: 2023/07/21
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Post-stroke spasticity (PSS) is a disorder of the sensory-motor control, leading to upper motor neuron lesions manifesting either as intermittent or sustained involuntary activation of muscles. Botulinum neurotoxin-A (BoNT-A) is mostly utilized in a variety of therapeutic indications, and it is effective and safe in the management of focal PSS in the rehabilitation scenario. The study aimed to evaluate the effect of BoNT-A administration on H-reflex of upper and lower limbs following PSS. In addition, the investigation of the association among the degree of spasticity (assessed by the Modified Ashworth Scale [MAS]) and motor neuron pool excitability (assessed by analysing H-reflex excitability) was done.

Material and methods:
Fifty patients with a stroke of either sex aged 30 to 60 years presented with either upper or lower limb focal spasticity were studied. BoNT-A was given on two occasions to the gastrocnemius, soleus, biceps brachii muscles and flexor carpi radialis (FCR). H-reflex was documented from the FCR and soleus muscles at baseline and 3-4 weeks post BoNT-A injection. Medical Research Council scale and MAS were used to assess the PSS and muscle strength.

H-reflex latency and amplitude, H/M ratio recorded from FCR and soleus muscles were significantly different between pre- and post-management. The MRC scale was significantly increased whereas the MAS was significantly reduced post BoNT-A injection.

BoNT-A causes obvious improvement in PSS clinically as assessed by MAS and MRC scale as well as neurophysiologically by H-reflex. A negative correlation between H-reflex latency but not the amplitude or Hmax/Mmax ratio and MAS was observed.


stroke, spasticity, H-reflex, BoNT-A

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