Dry Needling and Botulinum Toxin in the Management of Poststroke Spasticity
Condition: Spasticity, Muscle
MeSH terms: Muscle Spasticity
Study type: Interventional

Summary: 
      Stroke is a clinical picture that can result in loss of motor, sensory and cognitive
      functions or coma. Approximately 75% of stroke survivors develop disability and one of the
      causes of disability is the presence of spasticity. Effective treatment of spasticity
      accelerates functional recovery. Botulinum toxin type A (BTX-A) injection is a safe and
      effective method in the management of focal spasticity. As its effects over central and
      peripheral nervous system have been understood, dry needling has been recently introduced as
      the novel treatment of spasticity after stroke in clinical practice. Studies evaluating the
      efficacy of dry needling in the treatment of spasticity are limited in the literature and
      there is no data on the long-term efficacy of dry needling in current studies. On the other
      hand, the effects of dry needling when combined with other antispastic treatment modalities
      have not been investigated yet. In this study, the antispastic efficacy of dry needling
      applied with BTX-A injection was investigated.
    

Detailed description: 
      The study was designed as a prospective, randomized, single-blind study. Patients included in
      the study were selected from 59 stroke patients and randomized into two groups; BTX-A
      injections and exercise in BTX-A Group (n=15), and BTX-A injection and exercise, additionally
      with dry needling in BTX-A+Dry needling Group (n=15). All patients underwent 200 U BTX-A
      injections in biceps brachii muscle under sonographic guidance. Patients who were included in
      BTX-A+Dry needling Group underwent dry needling for 4 times in total following BTX-A
      injection, as the first one being administered immediately after the BTX-A injection, and the
      remaining three with a three-day interval (3rd, 6th and 9th days after BTX-A injection).
      Stretching exercises for the upper extremity spastic muscles and strengthening exercises for
      the antagonist muscles on the hemiplegic side were applied in both groups. Patients were
      followed for 3 months after injection. As a result, the data obtained in this study was
      compatible with the results that ultrasonography (US)-guided BTX-A injection to the upper
      extremity together with the rehabilitation program decreased the post-stroke spasticity,
      improved the upper extremity motor functions, and this improvement continued until 3 months
      after injection. In addition, dry needling combined with BTX-A injection and performed in a
      total of 4 sessions with three days intervals, contributes to the antispastic effect to start
      earlier, to be more effective and to maintain a longer-lasting effect.
    

Intervention name(s): Botulinum Toxin Type A; Botulinum Toxin Type A and dry needling.
Intervention type(s): Drug; Combination Product
Intervention description(s): 200 U Botulinum toxin type A injection in the spastic biceps brachii muscle.; Dry needling for 4 times in total in the spastic biceps brachii muscle after the Botulinum toxin type A injection.
Intervention MeSH terms: Botulinum Toxins; Botulinum Toxins, Type A; abobotulinumtoxinA
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Needling, botulinum, toxin, spasticity, stroke