Comparison of the Efficacy of 2 Different Botulinum Toxin Injection Techniques in Gastrocnemius Muscle Spasticity in Hemiplegic Patients: A Randomized Double-Blind Controlled Study.

OBJECTIVE

To compare the efficacy of the innervation zone-targeted injection technique (EUROMUSCULUS/USPRM (Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine) spasticity approach) and the injection technique along the muscle length.

DESIGN

A double-blind randomized controlled trial.

SETTING

Department of rehabilitation medicine of a medical center.

PARTICIPANTS

One hundred patients with stroke experiencing ankle plantar flexor spasticity.

INTERVENTIONS

In addition to conventional rehabilitation, eligible patients were randomly assigned to 2 groups. The experimental group was injected with botulinum toxin along the length of the muscle, whereas the control group was injected with the same dose and volume of botulinum toxin 25%-35% proximal to the medial head and 20%-30% proximal to the lateral aspect of the head of the gastrocnemius muscle.

MAIN OUTCOME MEASURES

Modified Ashworth scale, modified Tardieu scale, ankle range of motion measurement, and 10-meter walk test were used before and 1 month after injection.

RESULTS

The study was completed by 60 participants with a mean age of 59.96±12.15 years. Both injection methods were found to be effective on range of motion, spasticity level, ambulation, and walking speed. There was no statistically significant difference between injection methods.

CONCLUSIONS

Both injection methods of botulinum toxin A produce similar clinical effects.