Efficacy of Early Treatment with Onabotulinum Toxin A in Post-Stroke Spasticity

Abstract

Background To compare the effect of early versus delayed administration of Onabotulinum Toxin Type A (OnabotA) injections in patients with post-stroke spasticity in the Upper (UL) and/or Lower Limbs (LL). Methods A retrospective study, from 2014 to 2017, was conducted on consecutive patients with moderate to severe stroke according to the National institute of Health Stroke Scale (NIHSS) [NIHSS score 14 to 25]. All patients received individualized treatment with OnabotA (Allergan Inc., Irvine, CA, USA) at baseline in the affected limbs. Study patients were divided in two groups; Group I: Administration of Onabot A within the first 6 months after stroke and Group II: Administration of Onabot A later than 6 months after stroke. The primary end-point was the changes in muscle tone, assessed by means of the Modified Ashworth Scale (MAS), at the end of the 1-year treatment period. Results Of 162 screened patients, 32 met the inclusion/exclusion criteria and were included in the study. In the LL, the MAS score reduction was significantly greater (p=0.0452) in those patients who received OnabotA treatment at early stages. Similarly, the Onabot A dose received throughout the study was significantly lower in patients receiving toxin treatment early in the process (p=0.0003). For each day that treatment with OnabotA was delayed, MAS score was 0.003 units (EE=0.001) greater. Conclusion The results of this study suggested that early treatment with Onabot A administered in post-stroke spasticity patients was associated with a better evolution of the process.