Objective: This study aimed to provide clinical injection data and real-world patient-reported and clinical outcomes for the chemodenervation and neurolytic treatment of muscle overactivity including spasticity in patients with traumatic brain injury and stroke.
Design: This study used a prospective multicenter observational design. The participants were 487 patients with stroke or traumatic brain injury. The interventions used were onabotulinumtoxin A or phenol. Nine subjects received both onabotulinumtoxin A and phenol. The main outcome measures were satisfaction and goal attainment, pain, and Ashworth Scale scores.
Results: The most commonly treated pattern of dysfunction in the upper limb was the flexed wrist, with the flexor carpi radialis as the most frequently treated muscle. The mean total dose for the upper limb muscle was 57.7 ± 34.1 U, and phenol volume was 3.9 ± 0.7 ml. The most commonly treated pattern of dysfunction in the lower limb was the equinovarus/equinus foot, with the medial/lateral gastrocnemius as the most frequently treated muscles. The mean total dose for the lower limb muscle was 93.8 ± 63.5 U, and phenol volume was 4.1 ± 1.3 ml. There was a significant improvement in Ashworth Scale and pain scores. Generally, the patients reported that they were satisfied with their treatment and made progress toward their goals. No significant treatment-related adverse effects were reported.
Conclusions: Based on 487 patients with stroke and traumatic brain injury who were selected by their physician and clinical presentation for treatment using chemodenervation and neurolysis, this report of injection data reflecting actual clinical practice may serve as a further clinical guide in the management of patients with muscle overactivity, including spasticity.