Title:Combined Treatment Fkt-Botulinum Toxin Type A (Btx-A) in Patients with Strumpell-Lorrain Disease
Volume: 22
Issue: 6
Author(s): Marvulli Riccardo, Lopopolo Angela, Dantone Angela, Palmisano Vita, Lancioni Giulio, Fiore Pietroq, Ianieri Giancarlo and Megna Marisa
Affiliation:
Keywords:
Baropodometric examination, botulinum toxin type A (Btx-A), Hereditary Spastic Paraparesis, miometric evaluation,
physiotherapy, spasticity.
Abstract: The Hereditary Spastic Paraparesis (HSP) or Strumpell-Lorrain disease is a heterogeneous neurodegenerative
disease of the spinal cord. It is genetically transmitted and characterized by a progressive muscle weakness,
spasticity of the lower limbs and awkward gain. There is no specific pharmacological treatment. The pharmacological
therapy decreases the muscle tone and prevents stiffening). Physiotherapy restrains the progression of muscle
atrophy, delays contraction of the tendons and gives greater mobility to people affected by the disease. The aim of
this study is to demonstrate the efficacy of the combined treatment Fkt and Btx-A in patients with HSP.
Retrospective study was conducted recruiting ten patients with spasticity according to Asworth modified scale of at
least 2 and with gait deficit. They received treatment for 5 years with incobotulinumtoxinA and physiokinesiotherapy
for addressing spasticity in the lower limbs. We evaluated muscle tone with miometric measurement both at the first visit (T0), and at
subsequent ones (T1 after 30 days, T2 after 3 months from the first infiltration, T3 after 4 months up to the date of the following infiltration,
T4 after 5 months). Baropodometric examination has proven essential for the study of the distribution of loads in statics and dynamics.
The data analysis regarding tone assessment through measurements with Myoton highlighted hypertonus reduction in all the three muscle
groups examined at T1 and the maintenance of constant values up to 5 months after the first infiltration. It also showed an increase in the
percentage of back foot loading in both feet up to T4 (new inoculation, p<0, 05%). Baropodometric examination in dynamics (in particular
the speed of the step) showed a gradual increase in this parameter which reaches a peak at 5 months (p<0, 05%) and then declines
again in conjunction with the next infiltration treatment.
This study showed the benefit of combined treatment with Btx and Fkt. The use of a local muscle relaxant drug with a physical targeted
exercise guarantees better mobility of the treated segments, reducing tendon retractions as much as possible, and guarantees an adequate
postural alignment. Baropodometric examination highlights a more advantageous distribution load, quite essential for avoiding tendinitis
due to overload.
Our data observation in the 5 years study shows how the curve relative to the speed of step and the graphics related to the variations of
muscle tone remain almost constant with detectable improvement.
