Early use of Xeomin neurotoxin for local anti-spasticity therapy for pes equines after acquired brain injury (ABI)

Abstract

Primary objective: The acute management of spasticity following ABI is challenging. Contractures can occur during the acute phases of illness. The joints most affected are the shoulders and the ankles.

Research design: A case study of a 48-year-old female patient who received local chemoneurolytic anti-spasticity therapy following a severe subarachnoid haemorrhage for pes equines deformity is presented to illustrate the role of focal neurotoxin therapy.

Methods and procedures: The increasing spasticity in her legs was observed and could not be effectively treated with oral anti-spasticity agents or intensive physiotherapy. As spasticity increased (Modified Ashworth Scale 4), mobility of the right foot continued to deteriorate, leading to indication for local anti-spasticity treatment with Xeomin neurotoxin. The spastic pes equinus was injected with Xeomin® using a total dose of 150 U.

Main outcomes and results: On the 6th day after injection, a gradual reduction in spasticity was observed in the injected muscle (Modified Ashworth Scale 1–2) and an increasing improvement in joint mobility.

Conclusions: Early local anti-spasticity treatment with Xeomin is effective treatment. The cost of the intervention would appear to be high, but if one compares it with the costs of conservative treatment, it is not more expensive.

• Botulinum toxin
• Xeomin®
• spasticity
• intensive care
• brain injury