Stroke Rehabilitation Clinical Trial
Official title:
Effects of Repeated Use of Botulinum Neurotoxin Type A (BoNT/A) Free of Complexing Proteins in the Spastic Equinovarus Foot in Stroke Patients: A Randomized Clinical Trial
Clinical randomized clinical trial to assess the effectiveness on walking speed of repeated use of botulinum neurotoxin type A (BoNT/A)in the post-stroke spastic equinovarus foot in three successive infiltrations at 6-month intervals, checking if the sustainability of the effect is greater in incobotulinumtoxin A (Xeomin®) than in onabotulinumtoxinA (Botox®).
Spasticity is present in 38% of patients at six months after stroke. Equinovarus foot, with
or without claw toes and striatal foot, is especially common. There is a weak to moderate
evidence in favor of the use of botulinum neurotoxin type A (BoNT/A) in the equinovarus foot,
stiff-knee and in other patterns that may interfere with gait ability. Specifically, BoNT/A
increases walking speed in stroke patients with spastic equinovarus foot.
Repeated use of BoNT/A may lead to the appearance of neutralizing antibodies, so its effect
may decrease over successive infiltrations. Among the differential characteristics of
incobotulinumtoxinA (Xeomin®) there is a reduced inactivated botulinum neurotoxin content and
the lack of complexing proteins, which would diminish antigenicity and not suppose a decrease
of the effect before successive infiltrations.
The objective of this project is to determine the effect on walking speed of repeated use of
BoNT/A in post-stroke spinal equinovarus foot in three consecutive injections at 6-month
intervals and to investigate whether the sustainability of the effect is greater in
incobotulinumtoxinA (Xeomin®) than in onabotulinumtoxinA (Botox®). All patients will receive
200-300 units of BoNT/A (Xeomin ® or Botox ®) that will be distributed according to the
individual clinical pattern of spastic equinovarus foot.
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