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. 2018 Sep;8(9):e01069.
doi: 10.1002/brb3.1069. Epub 2018 Aug 23.

Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients

Elena Alvisi  1   2   3 , Mariano Serrao  4   5 , Carmela Conte  6 , Enrico Alfonsi  1 , Cristina Tassorelli  2   7 , Paolo Prunetti  2 , Silvano Cristina  7 , Armando Perrotta  8 , Francesco Pierelli  4   8 , Giorgio Sandrini  2   7
Affiliations

Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients

Elena Alvisi et al. Brain Behav. 2018 Sep.

Erratum in

Abstract

Objectives: The aims of this study were to evaluate the pattern of the nociceptive withdrawal reflex (NWR) of the upper limb at rest and after injection of Botulinum toxin type A (BoNT-A) in poststroke subacute hemiparetic patients.

Methods: Fourteen patients with poststroke subacute hemiparesis underwent clinical and instrumental evaluation and BoNT-A injection. Painful electrical stimulation was applied to induce the NWR. Baseline EMG activity and NWR recordings (EMG and kinematic response) were performed at T0, one month (T1), and three months (T2) after the BoNT-A injection, as were Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM) scores.

Results: Comparison of results at T0, T1, and T2 revealed significant changes in the MAS score for the elbow (p < 0.001) and wrist joints (p < 0.001) and in the FIM score at T0 and T2. BoNT-A injection had a significant effect on both NWR amplitude and baseline EMG activity in the posterior deltoid (PD) and flexor carpi radialis (FCR) muscles as well as in all averaged muscles. Analysis of elbow kinematics before and after treatment revealed that the reflex probability rates were significantly higher at T1 and T2 than at T0.

Conclusion: Injection of BoNT-A in the subacute phase of stroke can modify both the baseline EMG activity and the NWR-related EMG responses in the upper limb muscles irrespective of the site of injection; furthermore, the reflex-mediated defensive mechanical responses, that is, shoulder extension and abduction and elbow flexion, increased after treatment. BoNT-A injection may be a useful treatment in poststroke spasticity with a potential indirect effect on spinal neurons.

Keywords: botulinum toxin A; nociceptive withdrawal reflex; spasticity; stroke; upper limb.

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Figures

Figure 1
Figure 1
Baseline EMG activity in the AD, PD, BB, TB, FCR, and ECR muscles in a representative subject at baseline (T0) and 1 month (T1) and 3 months (T2) BoNT‐A injection. *p < 0.05 and **p < 0.01 at post hoc analysis
Figure 2
Figure 2
Nociceptive withdrawal reflex (NWR) amplitudes of AD, PD, BB, TB, FCR, and ECR muscles in all patients. The figure shows the mean and standard deviation values of the NWR amplitude before (T0) and 1 month (T1) and 3 months (T2) after BoNT‐A injection. *p < 0.05, at post hoc analysis
Figure 3
Figure 3
Mean baseline EMG activity in all patients before (T0) and 1 month (T1) and 3 months (T2) after BoNT‐A injection (a); mean nociceptive withdrawal reflex‐related EMG amplitude of all muscles in all patients before (T0) and 1 month (T1) and 3 months (T2) after BoNT‐A injection (b). *p < 0.05, at post hoc analysis
Figure 4
Figure 4
Kinematic reflex responses of the elbow (flexion–extension) in a representative subject at baseline (T0) and 1 month (T1) and 3 months (T2) after BoNT‐A injection. The black arrow indicates the stimulus delivery, and the gray dashes indicate the reflex detection windows. Note the increased elbow flexion at T1 and T2
Figure 5
Figure 5
EMG reflex responses of the PD, BB, TB, FCR, and ECR muscles in a representative subject before (T0) and 1 month (T1) and 3 months (T2) after BoNT‐A injection. The black lines represent the mean curves, while the gray bands represent the standard deviation. The black arrows indicate the stimulus delivery
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References

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