H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States of America.
Physical Medicine, Rehabilitation and Sports Medicine Department, University of Puerto Rico, School of Medicine, United States of America; Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center McGovern Medical School and the NeuroRecovery Research Center, TIRR Memorial Hermann, Houston, TX, United States of America.
J Neurol Sci. 2021 Jun 15;425:117449. doi: 10.1016/j.jns.2021.117449. Epub 2021 Apr 17.
Our primary objective was to compare early-start vs. late-start Botulinum toxin (BoNT) injections in post-stroke spasticity management. This is an IRB approved retrospective chart review of patients who were admitted for inpatient rehabilitation within 6 months after first-ever stroke between January 2014 and December 2018 and received BoNT injections within 15 months. The total dose and interval between consecutive injections were used as objective outcomes. 2367 stroke admissions were reviewed. 189 patients metinclusion criteria. 68 out of 189 patients received BoNT injections within 12 weeks after stroke (EARLY group). 20 patients in the EARLY group who received at least three cycles were included for analysis. Out of 189 patients, 47 patients were categorized into the Early- and Late-start subgroups each by time from stroke onset to first BoNT injection (1st and 4th quartiles of time distribution) for comparisons. In the EARLY group, the first interval (Mean (M) = 7.6 weeks, standard deviation (SD) = 2.14) was significantly shorter than the second interval (M = 23.7, SD = 10.41) and the third interval (M = 20.0, SD = 11.23; p < 0.05). The dose at the first cycle (M = 492 units, SD = 201.5) was significantly lower than the dose at the third cycle (M = 605, SD = 82.6). In comparison between the Early- and Late-start subgroups, the time to first BoNT injection was 6.4 weeks (range: 4.7-8.6) after stroke for the Early-start subgroup and 49.6 weeks (range: 27.4-62.3) after stroke for the Late-start subgroup. The subsequent intervals after the first injection were significantly longer in the Early-start subgroup (M = 23.1 weeks) than in the Late-start subgroup (M = 14.6 weeks) (p = 0.008). The average total dose of BoNT was significantly higher in the Early-start subgroup (M = 561.9 units, SD = 143.1) than the Late-start subgroup (M = 470.0, SD = 164.8) (p = 0.012). The findings showed that higher doses of BoNT were used in the Early-start group, and often resulted in longer intervals between subsequent injections than in the Late-start group.
我们的主要目标是比较早期开始与晚期开始肉毒毒素（BoNT）注射在中风后痉挛管理中的效果。这是一项经机构审查委员会批准的回顾性图表研究，纳入了 2014 年 1 月至 2018 年 12 月期间首次中风后 6 个月内住院康复且在 15 个月内接受 BoNT 注射的患者。总剂量和连续注射之间的间隔时间作为客观结果。共回顾了 2367 例中风入院病例。189 名患者符合纳入标准。189 名患者中有 68 名在中风后 12 周内（早期组）接受 BoNT 注射。早期组中有 20 名患者至少接受了三个周期的治疗，纳入分析。189 名患者中，47 名患者根据从中风发病到首次 BoNT 注射的时间（时间分布的第 1 四分位数和第 4 四分位数）被分为早期和晚期亚组进行比较。在早期组中，第一次间隔（均值（M）= 7.6 周，标准差（SD）= 2.14）明显短于第二次间隔（M = 23.7，SD = 10.41）和第三次间隔（M = 20.0，SD = 11.23；p < 0.05）。第一次循环的剂量（M = 492 单位，SD = 201.5）明显低于第三次循环的剂量（M = 605，SD = 82.6）。与早期和晚期亚组相比，早期亚组的首次 BoNT 注射时间为中风后 6.4 周（范围：4.7-8.6），晚期亚组为中风后 49.6 周（范围：27.4-62.3）。早期亚组的首次注射后的后续间隔明显长于晚期亚组（M = 23.1 周）（M = 14.6 周）（p = 0.008）。早期亚组的 BoNT 平均总剂量（M = 561.9 单位，SD = 143.1）明显高于晚期亚组（M = 470.0，SD = 164.8）（p = 0.012）。结果表明，早期组使用了更高剂量的 BoNT，并且通常导致随后的注射间隔时间长于晚期组。
