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A Randomized Controlled Trial of Selective Neurotomy Versus Botulinum Toxin for Spastic Equinovarus Foot After Stroke.

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Bollens, Benjamin [UCL] Gustin, Thierry [UCL] Stoquart, Gaëtan [UCL] Detrembleur, Christine [UCL] Lejeune, Thierry [UCL] Deltombe, Thierry [UCL]

BACKGROUND: . Selective neurotomy is a permanent treatment of focal spasticity, and its effectiveness in treating spastic equinovarus of the foot (SEF) was previously suggested by a few nonrandomized and uncontrolled case-series studies. OBJECTIVES: . This study is the first assessor-blinded, randomized, controlled trial evaluating the effects of this treatment. METHODS: . Sixteen chronic stroke patients presenting with SEF were randomized into 2 groups: 8 patients underwent a tibial neurotomy and the remaining 8 received botulinum toxin (BTX) injections. The soleus was treated in all patients, and the tibialis posterior and flexor hallucis longus were treated in about half of patients. The primary outcome was the quantitative measurement of ankle stiffness (L-path), an objective measurement directly related to spasticity. Participants were assessed by a blind assessor before their intervention and at 2 and 6 months after treatment. Evaluations were based on the 3 domains of the International Classification of Functioning, Disability and Health (ICF). RESULTS: . Compared with BTX, tibial neurotomy induced a higher reduction in ankle stiffness. Both treatments induced a comparable improvement of ankle kinematics during gait, whereas neither induced muscle weakening. Activity, participation, and quality of life were not significantly modified in either group. CONCLUSIONS: . This study demonstrates that the tibial nerve neurotomy is an effective treatment of SEF, reducing the impairments observed in chronic stroke patients. Future studies should be conducted to confirm the long-term efficacy based on the ICF domains.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2013
Language Anglais
Journal information "Neurorehabilitation and neural repair" - Vol. 27, no. 8, p. 695-703 (2013)
Peer reviewed yes
Publisher SAGE Publications: Meredith Pond and Courtney Pugh (Philadelphia)
issn 1545-9683
e-issn 1552-6844
Publication status Publié
Affiliations UCL - SSS/IONS/COSY - Systems & cognitive Neuroscience
UCL - (SLuc) Service de médecine physique et de réadaptation motrice
UCL - (MGD) Service de médecine physique et revalidation
UCL - (MGD) Service de neurochirurgie
UCL - SSS/IONS/NEUR - Clinical Neuroscience
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Bibliographic reference Bollens, Benjamin ; Gustin, Thierry ; Stoquart, Gaëtan ; Detrembleur, Christine ; Lejeune, Thierry ; et. al. A Randomized Controlled Trial of Selective Neurotomy Versus Botulinum Toxin for Spastic Equinovarus Foot After Stroke.. In: Neurorehabilitation and neural repair, Vol. 27, no. 8, p. 695-703 (2013)
Permanent URL http://hdl.handle.net/2078.1/131321