Background: The management of spasticity remains a major challenge in rehabilitation medicine. Many studies have demonstrated the efficacy of local injections of botulinum toxin A (BTX-A) into the upper limb for reducing spasticity. Lidocaine has been used as a nerve block for the treatment of spasticity of the upper limb.
Objectives: to evaluate the outcome and to compare the efficacy of rehabilitation program after botulinum toxin type-A injection versus serial lidocaine injections.
Patients and methods: 50 patients suffering from spasticity of the upper limb after stroke attending the Rehabilitation Clinic were enrolled in the study. Assessment of spasticity, upper limb function, self care ability and pain were done by using the Modified Ashworth Scale (MAS), Medical research council scale (MRCS), the Barthel-Index and Visual Analogue Scale (VAS) respectively. Electrophysiological assessment was done by conventional nerve conduction studies; H-Reflex and Hmax/Mmax ratio and F-wave and F/M ratio. The patients were divided into two equal groups. The first group submitted to botulinum toxin type-A intramuscular injection and the second group submitted to 10 serial lidocaine intramuscular motor point block. Both groups were subjected to the same rehabilitation program after injection and had been worn the suitable orthotic. Evaluation of all patients had been done before treatment and at one and four month after treatment.
Results: the spasticity in both studied groups was alleviated and the patients experienced relief of pain, increase muscle power and decrease disability. These acquired benefits continued through the fellow up period. No much difference found between efficacies of the two treatment modalities used in this study.
Conclusion: Lidocaine might be considered as an effective and costless in the symptomatic treatment of the post stroke upper limb spasticity. The study suggests that this effect can be maintained with repeated serial and booster dose injections and intensive regular rehabilitation program.
