Long-Term Management of Post-Stroke Spasticity with Botulinum Toxin: A Retrospective Study

Abstract

Stroke-induced spasticity is a prevalent condition affecting stroke survivors, significantly impacting their quality of life. Botulinum Toxin A injections are widely used for its management, yet the long-term effects and optimal management strategies remain uncertain. This retrospective study analyzed medical records of 95 chronic stroke patients undergoing long-term BoNT-A treatment for spasticity. Demographic data, treatment duration, dosage variability, and dropout rates were assessed over a period ranging from 2 to 14 years. The study revealed a notable extension of the interval between BoNT-A injections throughout the treatment duration. Dropout rates peaked during the initial 5 years of treatment, perhaps due to perceived treatment ineffectiveness. Additionally, a trend of escalating dosage was observed across all groups, indicating a potential rise in the severity of spasticity or changes in treatment response over time. BoNT-A injections emerged as the predominant treatment choice for managing post-stroke spasticity. The delayed initiation of BoNT-A treatment underscores the need for heightened awareness among healthcare providers to recognize and manage spasticity promptly post-stroke. Patients' expectations and treatment goals should be clearly defined to optimize treatment adherence, while the observed escalation in dosage and treatment intervals emphasizes the dynamic nature of spasticity and underscores the importance of monitoring long-term treatment outcomes.

Keywords: botulinum toxin A; long-term management; spasticity; stroke; treating.

Figure A1

Distribution of the mean intervals between injections for each year of treatment. Horizontal lines indicate medians and black dots indicate means. Whiskers extend to points that lie within 1.5 interquartile ranges of the lower and upper quartiles.

Figure A2

Distribution of the mean dosage for each year of treatment. Horizontal lines indicate medians and black dots indicate means. Whiskers extend to points that lie within 1.5 interquartile ranges of the lower and upper quartiles.

Figure A3

Mean intervals between injections of individual patients who took anti-spasticity drugs (open red circles) and those who did not take anti-spasticity drugs (open cyan circles) represented as a scatterplot, with intervals in the first year of treatment shown on the abscissa and intervals in the last year of treatment shown on the ordinate. A jitter was added to the data points to limit the superposition of circles. Larger filled color-coded circles represent the mean values of each group.

Figure A4

Dosages of individual patients who took anti-spasticity drugs (open red circles) and those who did not take anti-spasticity drugs (open cyan circles) represented as a scatterplot, with the first dosage of treatment shown on the abscissa and the last dosage of treatment shown on the ordinate. A jitter was added to the data points to limit the superposition of circles. Larger filled color-coded circles represent the mean values of each group.

Figure 1

Number of dropouts by year of treatment. Numbers above the bars indicate the cumulative percentage of dropouts.

Figure 2

(A) Distribution of the mean intervals between injections in the first and last year of treatment in all patients. Horizontal lines indicate medians and black dots indicate means. Whiskers extend to points that lie within 1.5 interquartile ranges of the lower and upper quartiles. (B) Distribution of the mean intervals between injections in the first (red) and last year (cyan) of treatment separately for the SIT and LIT groups. The same graphical conventions are used as in panel (A). Asterisks indicate larger intervals in the last year of treatment than in the first. ***, p < 0.001, *, p < 0.05.

Figure 3

(A) Distribution of the dosage in the first and in the last injection in all patients. Horizontal lines indicate medians and black dots indicate means. Whiskers extend to points that lie within 1.5 interquartile ranges of the lower and upper quartiles. (B) Distribution of the dosage in the first (red) and last injection (cyan) of treatment separately for the SIT and LIT groups. The same graphical conventions were are as in panel (A). Asterisks indicate a greater dosage in the last injection than in the first. **, p < 0.01, *, p < 0.05.

Figure 4

Flow chart of the retrospective patients’ selection for data acquisition and statistical analysis.