When a stroke leaves a patient with disabling spasticity, botulinum toxin type A (BotoxTM, Allergan) may help restore enough muscle function to make life easier. In a multicenter trial of 126 patients, those who were given one-time intramuscular injections of botulinum toxin type A experienced greater improvement in flexor tone in the wrist and fingers at all follow-up visits through 12 weeks compared with patients who received placebo. Each patient (or care-giver) chose a principal target of treatment from four areas of disability: hygiene (e.g., ease of cleaning and nail trimming), dressing, limb position, and pain. At week six, 40 of 64 patients given botulinum toxin type A reported improvement in the individual principal target of treatment compared with 17 of 62 in the placebo group. No major adverse events were associated with the injection.
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The researchers point out that botu-linum toxin type A has a localized effect, which minimizes the risk of systemic adverse events.