Pain and Muscles Properties Modifications After Botulinum Toxin Type A (BTX-A) and Radial Extracorporeal Shock Wave (rESWT) Combined Treatment

Author(s): Megna Marisa*, Marvulli Riccardo, Farì Giacomo, Gallo Giulia, Dicuonzo Franca, Fiore Pietro, Ianieri Giancarlo.

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets
(Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders)

Volume 19 , Issue 8 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background and Objective: Spasticity (most common disability in upper motor neuron syndrome or UMNS) caused an inability of patients’ to perform daily activities and a decrease inquality of life. One of the promising methods nowadays, but still not widely used in everyday practice, for spasticity reduction is extracorporeal shock wave. The aim of this study was to evaluate the objective clinical effects of combined treatment botulinum toxin type A and radial Extracorporeal Shock Wave Therapy in spasticity post stroke.

Methods: We considered 30 subjects (14 female and 16 male) with post stroke spasticity of Biceps Brachii, Superficial Flexor Digitorum, Gastrocnemius Medialis and Lateralis and we divided patients into two groups (group A received botulinum toxin injection and physiotherapy while group B received botulinum toxin injection, rESWT and physiotherapy). Assessments were performed before treatment (t0), after 1 (t1), 2 (t2) e 3 (t3) months using Modified Ahworth Scale, Visual Analogical Scale for pain and MyotonPro® device (to assessed myometric evaluation of muscles tone and stiffness).

Results: Visual Analogical Scale, Modified Ahworth Scale, muscles tone and stiffness statistically decreased until t3 in the group A and in the group B, but the differences between the two groups were significant at the t1 only.

Conclusion: Radial Extracorporeal Shock Wave Therapy could be an effective physical treatment aimed at the reduction of upper and lower limbs spasticity and could lead to the improvement of trophic conditions of the spastic muscles in post-stroke.

Keywords: Botulinumtoxin type A, radial extracorporeal shock waves therapy, spasticity, pain, myometric examination, physiotherapy.

[1]
Dymarek, R.; Taradaj, J.; Rosińczuk, J. Extracorporeal Shock Wave Stimulation as Alternative Treatment Modality for Wrist and Fingers Spasticity in Poststroke Patients: A Prospective, Open- Label, Preliminary Clinical Trial. Evid. Based Complement. Alternat. Med., 2016, 20164648101
[http://dx.doi.org/10.1155/2016/4648101] [PMID: 27504139]
[2]
Sacco, R.L.; Kasner, S.E.; Broderick, J.P.; Caplan, L.R.; Connors, J.J.; Culebras, A.; Elkind, M.S.; George, M.G.; Hamdan, A.D.; Higashida, R.T.; Hoh, B.L.; Janis, L.S.; Kase, C.S.; Kleindorfer, D.O.; Lee, J.M.; Moseley, M.E.; Peterson, E.D.; Turan, T.N.; Valderrama, A.L.; Vinters, H.V. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2013, 44(7), 2064-2089.
[http://dx.doi.org/10.1161/STR.0b013e318296aeca] [PMID: 23652265]
[3]
Członkowska, A.; Niewada, M.; Saleh El-Baroni, I.; Mendel, T.; Ryglewicz, D.; Sandercock, P.; Lewis, S. High early case fatality after ischaemic stroke in Poland: exploration of possible explanations in the International Stroke Trial. J. Neurol. Sci., 2002, 202(1-2), 53-57.
[http://dx.doi.org/10.1016/S0022-510X(02)00203-4] [PMID: 12220692]
[4]
Heuschmann, P.U.; Wiedmann, S.; Wellwood, I.; Rudd, A.; Di Carlo, A.; Bejot, Y.; Ryglewicz, D.; Rastenyte, D.; Wolfe, C.D. Three-month stroke outcome: the European Registers of Stroke (EROS) investigators. Neurology, 2011, 76(2), 159-165.
[http://dx.doi.org/10.1212/WNL.0b013e318206ca1e] [PMID: 21148118]
[5]
Marciniak, C. Poststroke hypertonicity: upper limb assessment and treatment. Top. Stroke Rehabil., 2011, 18(3), 179-194.
[http://dx.doi.org/10.1310/tsr1803-179] [PMID: 21642056]
[6]
Veerbeek, J.M.; van Wegen, E.; van Peppen, R.; van der Wees, P.J.; Hendriks, E.; Rietberg, M.; Kwakkel, G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One, 2014, 9(2)e87987
[http://dx.doi.org/10.1371/journal.pone.0087987] [PMID: 24505342]
[7]
Lee, J.Y.; Kim, S.N.; Lee, I.S.; Jung, H.; Lee, K.S.; Koh, S.E. Effects of extracorporeal shock wave therapy on spasticity in patients after brain injury: a meta-analysis. J. Phys. Ther. Sci., 2014, 26(10), 1641-1647.
[http://dx.doi.org/10.1589/jpts.26.1641] [PMID: 25364134]
[8]
Amelio, E.; Manganotti, P. Effect of shock wave stimulation on hypertonic plantar flexor muscles in patients with cerebral palsy: a placebo-controlled study. J. Rehabil. Med., 2010, 42(4), 339-343.
[http://dx.doi.org/10.2340/16501977-0522] [PMID: 20358168]
[9]
Gonkova, M.I.; Ilieva, E.M.; Ferriero, G.; Chavdarov, I. Effect of radial shock wave therapy on muscle spasticity in children with cerebral palsy. Int. J. Rehabil. Res., 2013, 36(3), 284-290.
[http://dx.doi.org/10.1097/MRR.0b013e328360e51d] [PMID: 23603803]
[10]
Marinelli, L.; Mori, L.; Solaro, C.; Uccelli, A.; Pelosin, E.; Currà, A.; Molfetta, L.; Abbruzzese, G.; Trompetto, C. Effect of radial shock wave therapy on pain and muscle hypertonia: a double-blind study in patients with multiple sclerosis. Mult. Scler., 2015, 21(5), 622-629.
[http://dx.doi.org/10.1177/1352458514549566] [PMID: 25257616]
[11]
Kim, T.G.; Bae, S.H.; Kim, G.Y.; Kim, K.Y. The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis. J. Phys. Ther. Sci., 2015, 27(2), 523-526.
[http://dx.doi.org/10.1589/jpts.27.523] [PMID: 25729207]
[12]
Moon, S.W.; Kim, J.H.; Jung, M.J.; Son, S.; Lee, J.H.; Shin, H.; Lee, E.S.; Yoon, C.H.; Oh, M.K. The effect of extracorporeal shock wave therapy on lower limb spasticity in subacute stroke patients. Ann. Rehabil. Med., 2013, 37(4), 461-470.
[http://dx.doi.org/10.5535/arm.2013.37.4.461] [PMID: 24020026]
[13]
Troncati, F.; Paci, M.; Myftari, T.; Lombardi, B. Extracorporeal Shock Wave Therapy reduces upper limb spasticity and improves motricity in patients with chronic hemiplegia: a case series. NeuroRehabilitation, 2013, 33(3), 399-405.
[PMID: 23949081]
[14]
Sohn, M.K.; Cho, K.H.; Kim, Y.J.; Hwang, S.L. Spasticity and electrophysiologic changes after extracorporeal shock wave therapy on gastrocnemius. Ann. Rehabil. Med., 2011, 35(5), 599-604.
[http://dx.doi.org/10.5535/arm.2011.35.5.599] [PMID: 22506181]
[15]
Pitcher, C.A.; Elliott, C.M.; Panizzolo, F.A.; Valentine, J.P.; Stannage, K.; Reid, S.L. Ultrasound characterization of medial gas-trocnemius tissue composition in children with cerebral palsy. Muscle Nerve, 2014.
[16]
Picelli, A.; La Marchina, E.; Gajofatto, F.; Pontillo, A.; Vangelista, A.; Filippini, R.; Baricich, A.; Cisari, C.; Smania, N. Sonographic and clinical effects of botulinum toxin Type A combined with extracorporeal shock wave therapy on spastic muscles of children with cerebral palsy. Dev. Neurorehabil., 2017, 20(3), 160-164.
[http://dx.doi.org/10.3109/17518423.2015.1105320] [PMID: 26890193]
[17]
Picelli, A.; La Marchina, E.; Gajofatto, F.; Pontillo, A.; Vangelista, A.; Filippini, R.; Baricich, A.; Cisari, C.; Smania, N. Sonographic and clinical effects of botulinum toxin Type A combined with extracorporeal shock wave therapy on spastic muscles of children with cerebral palsy. Dev. Neurorehabil., 2017, 20(3), 160-164.
[http://dx.doi.org/10.3109/17518423.2015.1105320] [PMID: 26890193]
[18]
Fehlings, D.; Novak, I.; Berweck, S.; Hoare, B.; Stott, N.S.; Russo, R.N. Botulinum toxin assessment, intervention and follow-up for paediatric upper limb hypertonicity: international consensus statement. Eur. J. Neurol., 2010, 17(Suppl. 2), 38-56.
[http://dx.doi.org/10.1111/j.1468-1331.2010.03127.x] [PMID: 20633178]
[19]
Ianieri, G.; Saggini, R.; Marvulli, R.; Tondi, G.; Aprile, A.; Ranieri, M.; Benedetto, G.; Altini, S.; Lancioni, G.E.; Goffredo, L.; Bellomo, R.G.; Megna, M.; Megna, G. New approach in the assessment of the tone, elasticity and the muscular resistance: nominal scales vs MYOTON. Int. J. Immunopathol. Pharmacol., 2009, 22(3)(Suppl.), 21-24.
[http://dx.doi.org/10.1177/03946320090220S304] [PMID: 19887038]
[20]
Ianieri, G.; Saggini, R.; Marvulli, R.; Tondi, G.; Aprile, A.; Ranieri, M.; Di Teo, L.; Altini, S.; Lancioni, G.E.; Goffredo, L.; Megna, M.; Megna, G. Botulinum toxin in cerebral child palsy. Int. J. Immunopathol. Pharmacol., 2009, 22(3)(Suppl.), 9-11.
[http://dx.doi.org/10.1177/03946320090220S302] [PMID: 19887036]
[21]
Dymarek, R.; Bidzińska, G.; Zwierzchowski, K.; Słupska, L.; Ptaszkowski, K.; Halski, T. [Evaluation of the effectiveness of extracorporeal shock wave therapy in selected musculoskeletal system disorders of the inflammatory etiology--a critical review of the literature Wiad. Lek., 2015, 68(2), 183-192.
[PMID: 26181155]
[22]
Choi, Y.M.; Hong, S.H.; Lee, C.H.; Kang, J.H.; Oh, J.S. Extracorporeal shock wave therapy for painful chronic neurogenic heterotopic ossification after traumatic brain injury: a case report. Ann. Rehabil. Med., 2015, 39(2), 318-322.
[http://dx.doi.org/10.5535/arm.2015.39.2.318] [PMID: 25932431]
[23]
Lohse-Busch, H.; Reime, U.; Falland, R. Symptomatic treatment of unresponsive wakefulness syndrome with transcranially focused extracorporeal shock waves. NeuroRehabilitation, 2014, 35(2), 235-244.
[PMID: 24990026]
[24]
Notarnicola, A.; Covelli, I.; Maccagnano, G.; Marvulli, R.; Mastromauro, L.; Ianieri, G.; Boodhoo, S.; Turitto, A.; Petruzzella, L.; Farì, G.; Bianchi, F.P.; Tafuri, S.; Moretti, B. Extracorporeal shockwave therapy on muscle tissue: the effects on healthy athletes. J. Biol. Regul. Homeost. Agents, 2018, 32(1), 185-193.
[PMID: 29504386]
[25]
Wang, C.J.; Cheng, J.H.; Huang, C.C.; Yip, H.K.; Russo, S. Extracorporeal shockwave therapy for avascular necrosis of femoral head. Int. J. Surg., 2015, 24(Pt B), 184-187.
[http://dx.doi.org/10.1016/j.ijsu.2015.06.080] [PMID: 26188081]
[26]
Tinazzi, E.; Amelio, E.; Marangoni, E.; Guerra, C.; Puccetti, A.; Codella, O.M.; Simeoni, S.; Cavalieri, E.; Montagnana, M.; Adani, R.; Corrocher, R.; Lunardi, C. Effects of shock wave therapy in the skin of patients with progressive systemic sclerosis: a pilot study. Rheumatol. Int., 2011, 31(5), 651-656.
[http://dx.doi.org/10.1007/s00296-009-1339-z] [PMID: 20066427]
[27]
D., Agostino M.C.; Frairia, R.; Romeo, P.; Amelio, E.; Berta, L.; Bosco, V.; Gigliotti, S.; Guerra, C.; Messina, S.; Messuri, L.; Moretti, B.; Notarnicola, A.; Maccagnano, G.; Russo, S.; Saggini, R.; Vulpiani, M.C.; Buselli, P. Extracorporeal shockwaves as regenerative therapy in orthopedic traumatology: a narrative review from basic research to clinical practice. J. Biol. Regul. Homeost. Agents, 2016, 30(2), 323-332.
[PMID: 27358117]
[28]
Dymarek, R.; Ptaszkowski, K.; Słupska, L.; Halski, T.; Taradaj, J.; Rosi’nczuk, J. Effects of extracorporeal shock wave on upper and lower limb spasticity in post-stroke patients: A [29] narrative review. Top. Stroke Rehabil., 23(4), 293-303.
[http://dx.doi.org/10.1080/10749357.2016.1141492]
[29]
Dymarek, R.; Ptaszkowski, K.; Słupska, L.; Halski, T.; Taradaj, J.; Rosińczuk, J. Effects of extracorporeal shock wave on upper and lower limb spasticity in post-stroke patients: A narrative review. Top. Stroke Rehabil., 2016, 23(4), 293-303.
[http://dx.doi.org/10.1080/10749357.2016.1141492] [PMID: 27077981]
[30]
Manganotti, P.; Amelio, E. Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke. Stroke, 2005, 36(9), 1967-1971.
[http://dx.doi.org/10.1161/01.STR.0000177880.06663.5c] [PMID: 16109905]
[31]
Smania, N.; Picelli, A.; Munari, D.; Geroin, C.; Ianes, P.; Waldner, A.; Gandolfi, M. Rehabilitation procedures in the management of spasticity. Eur. J. Phys. Rehabil. Med., 2010, 46(3), 423-438.
[PMID: 20927008]
[32]
Marvulli, R.; Ianieri, G.; Mastromauro, L.; Romanelli, E.; Barulli, L.; Chiumarulo, P.; Megna, G.; Megna, M. Objective Assessment of the Rheological Muscle Property in the Treatment of Fibromyalgia. Endocr. Metab. Immune Disord. Drug Targets, 2015, 15(3), 229-233.
[http://dx.doi.org/10.2174/1871530315666150324112722] [PMID: 25809192]
[33]
Marvulli, R.; Ianieri, G.; Megna, G.; Lancioni, G.; Saggini, R.; Ranieri, M.; Cristella, G.; Megna, M. Botulinum toxin type A in cervical dystonia. Int. J. Immunopathol. Pharmacol., 2012, 25(1)(Suppl.), 23S-28S.
[http://dx.doi.org/10.1177/03946320120250S104] [PMID: 22652158]
[34]
Vidal, X.; Morral, A.; Costa, L.; Tur, M. Radial extracorporeal shock wave therapy (rESWT) in the treatment of spasticity in cerebral palsy: a randomized, placebo-controlled clinical trial. NeuroRehabilitation, 2011, 29(4), 413-419.
[PMID: 22207070]
[35]
Marvulli, R.; Mastromauro, L.; Romanelli, E.; Lopopolo, A.; Dargenio, M.; Fornarelli, F.; Conte, E.; Fiore, P.; Megna, M.; Ianieri, G. How Botulinum Toxin Type A- Occupational Ther-apy (OT)-Functional Electrical Stimulation (FES) Modify Spasticity and Functional Recovery in Patients with Upper Limb Spasticity Post Stroke. Clin. Immunol. Endocr. Metab. Drugs, 2016, 3(1), 62-67.
[http://dx.doi.org/10.2174/2212707003666160728143344]
[36]
Picelli, A.; Tamburin, S.; Cavazza, S.; Scampoli, C.; Manca, M.; Cosma, M.; Berto, G.; Vallies, G.; Roncari, L.; Melotti, C.; Santilli, V.; Smania, N. Relationship between ultrasonographic, electromyographic, and clinical parameters in adult stroke patients with spastic equinus: an observational study. Arch. Phys. Med. Rehabil., 2014, 95(8), 1564-1570.
[http://dx.doi.org/10.1016/j.apmr.2014.04.011] [PMID: 24792138]
[37]
Riccardo, M.; Angela, L.; Angela, D.; Vita, P.; Giulio, L.; Pietroq, F.; Giancarlo, I.; Marisa, M. Combined Treatment Fkt-Botulinum Toxin Type A (Btx-A) in Patients with Strumpell-Lorrain Disease. Curr. Pharm. Des., 2016, 22(6), 758-763.
[http://dx.doi.org/10.2174/1381612822666151204001830] [PMID: 26648460]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 19
ISSUE: 8
Year: 2019
Page: [1127 - 1133]
Pages: 7
DOI: 10.2174/1871530319666190306101322
Price: $65

Article Metrics

PDF: 46
HTML: 1
EPUB: 1
PRC: 1