Combined effects of botulinum toxin type A and repetitive transcranial magnetic stimulation with intensive motor training immediately after injection in a patient with chronic stroke: A case report

Yuichi Hirakawa, Soichiro Koyama, Shigeo Tanabe, Kazuya Takeda, Tetsuya Ueda, Ikuo Motoya, Hiroaki Sakurai, Yoshikiyo Kanada, Nobutoshi Kawamura, Mami Kawamura, Junji Nagata, Tetsuo Kanno

Research output: Contribution to journalArticle

Abstract

Study Design: Single case report. Introduction: A previous study clarified that spasticity and motor function were improved by combined treatment with botulinum toxin type A (BTX) injection and 1-Hz repetitive transcranial magnetic stimulation (rTMS) with intensive motor training at 4 weeks after injection. However, it is not clear whether 1-Hz rTMS with intensive motor training immediately after BTX injection also improves spasticity and motor function in stroke patients. Purpose of the Case Report: The purpose of this case report is to test the short- and long-term effects of BTX injection and rTMS with intensive motor training on the spasticity, motor function, and usefulness of the paretic hand in a stroke patient. Methods: A 64-year-old male, who suffered from a right cerebral hemorrhage 53 months previously, participated in the present study. BTX was injected into the spastic muscles of the affected upper limb. He then received the new protocol for a total of 24 sessions. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Activity Log, consisting of the amount of use and quality of movement scales, were assessed before and immediately after BTX injection, at discharge, and monthly for up to 5 months after discharge. Results: For the short-term effects of the therapy, the MAS scores of the elbow and wrist, FMA score, and quality of movement score improved. For the long-term effects of the therapy, the MAS score of the fingers, FMA score, and amount of use score improved for up to 5 months after discharge. Conclusions: The present case report showed the improvement of all assessments performed in the short and/or long term and suggest the possibility of shortening the intervention period of combined therapy of BTX and rTMS with intensive motor training.

Original languageEnglish
JournalJournal of Hand Therapy
DOIs
Publication statusAccepted/In press - 01-01-2018

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Type A Botulinum Toxins
Transcranial Magnetic Stimulation
Stroke
Injections
Muscle Spasticity
Cerebral Hemorrhage
Therapeutics
Elbow
Wrist
Upper Extremity
Fingers
Motor Activity
Hand
Muscles

All Science Journal Classification (ASJC) codes

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

@article{97f5f2b70c8946078d991dcefdd1b768,
title = "Combined effects of botulinum toxin type A and repetitive transcranial magnetic stimulation with intensive motor training immediately after injection in a patient with chronic stroke: A case report",
abstract = "Study Design: Single case report. Introduction: A previous study clarified that spasticity and motor function were improved by combined treatment with botulinum toxin type A (BTX) injection and 1-Hz repetitive transcranial magnetic stimulation (rTMS) with intensive motor training at 4 weeks after injection. However, it is not clear whether 1-Hz rTMS with intensive motor training immediately after BTX injection also improves spasticity and motor function in stroke patients. Purpose of the Case Report: The purpose of this case report is to test the short- and long-term effects of BTX injection and rTMS with intensive motor training on the spasticity, motor function, and usefulness of the paretic hand in a stroke patient. Methods: A 64-year-old male, who suffered from a right cerebral hemorrhage 53 months previously, participated in the present study. BTX was injected into the spastic muscles of the affected upper limb. He then received the new protocol for a total of 24 sessions. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Activity Log, consisting of the amount of use and quality of movement scales, were assessed before and immediately after BTX injection, at discharge, and monthly for up to 5 months after discharge. Results: For the short-term effects of the therapy, the MAS scores of the elbow and wrist, FMA score, and quality of movement score improved. For the long-term effects of the therapy, the MAS score of the fingers, FMA score, and amount of use score improved for up to 5 months after discharge. Conclusions: The present case report showed the improvement of all assessments performed in the short and/or long term and suggest the possibility of shortening the intervention period of combined therapy of BTX and rTMS with intensive motor training.",
author = "Yuichi Hirakawa and Soichiro Koyama and Shigeo Tanabe and Kazuya Takeda and Tetsuya Ueda and Ikuo Motoya and Hiroaki Sakurai and Yoshikiyo Kanada and Nobutoshi Kawamura and Mami Kawamura and Junji Nagata and Tetsuo Kanno",
year = "2018",
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doi = "10.1016/j.jht.2018.01.008",
language = "English",
journal = "Journal of Hand Therapy",
issn = "0894-1130",
publisher = "Hanley and Belfus Inc.",

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Combined effects of botulinum toxin type A and repetitive transcranial magnetic stimulation with intensive motor training immediately after injection in a patient with chronic stroke : A case report. / Hirakawa, Yuichi; Koyama, Soichiro; Tanabe, Shigeo; Takeda, Kazuya; Ueda, Tetsuya; Motoya, Ikuo; Sakurai, Hiroaki; Kanada, Yoshikiyo; Kawamura, Nobutoshi; Kawamura, Mami; Nagata, Junji; Kanno, Tetsuo.

In: Journal of Hand Therapy, 01.01.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Combined effects of botulinum toxin type A and repetitive transcranial magnetic stimulation with intensive motor training immediately after injection in a patient with chronic stroke

T2 - A case report

AU - Hirakawa, Yuichi

AU - Koyama, Soichiro

AU - Tanabe, Shigeo

AU - Takeda, Kazuya

AU - Ueda, Tetsuya

AU - Motoya, Ikuo

AU - Sakurai, Hiroaki

AU - Kanada, Yoshikiyo

AU - Kawamura, Nobutoshi

AU - Kawamura, Mami

AU - Nagata, Junji

AU - Kanno, Tetsuo

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Study Design: Single case report. Introduction: A previous study clarified that spasticity and motor function were improved by combined treatment with botulinum toxin type A (BTX) injection and 1-Hz repetitive transcranial magnetic stimulation (rTMS) with intensive motor training at 4 weeks after injection. However, it is not clear whether 1-Hz rTMS with intensive motor training immediately after BTX injection also improves spasticity and motor function in stroke patients. Purpose of the Case Report: The purpose of this case report is to test the short- and long-term effects of BTX injection and rTMS with intensive motor training on the spasticity, motor function, and usefulness of the paretic hand in a stroke patient. Methods: A 64-year-old male, who suffered from a right cerebral hemorrhage 53 months previously, participated in the present study. BTX was injected into the spastic muscles of the affected upper limb. He then received the new protocol for a total of 24 sessions. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Activity Log, consisting of the amount of use and quality of movement scales, were assessed before and immediately after BTX injection, at discharge, and monthly for up to 5 months after discharge. Results: For the short-term effects of the therapy, the MAS scores of the elbow and wrist, FMA score, and quality of movement score improved. For the long-term effects of the therapy, the MAS score of the fingers, FMA score, and amount of use score improved for up to 5 months after discharge. Conclusions: The present case report showed the improvement of all assessments performed in the short and/or long term and suggest the possibility of shortening the intervention period of combined therapy of BTX and rTMS with intensive motor training.

AB - Study Design: Single case report. Introduction: A previous study clarified that spasticity and motor function were improved by combined treatment with botulinum toxin type A (BTX) injection and 1-Hz repetitive transcranial magnetic stimulation (rTMS) with intensive motor training at 4 weeks after injection. However, it is not clear whether 1-Hz rTMS with intensive motor training immediately after BTX injection also improves spasticity and motor function in stroke patients. Purpose of the Case Report: The purpose of this case report is to test the short- and long-term effects of BTX injection and rTMS with intensive motor training on the spasticity, motor function, and usefulness of the paretic hand in a stroke patient. Methods: A 64-year-old male, who suffered from a right cerebral hemorrhage 53 months previously, participated in the present study. BTX was injected into the spastic muscles of the affected upper limb. He then received the new protocol for a total of 24 sessions. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Activity Log, consisting of the amount of use and quality of movement scales, were assessed before and immediately after BTX injection, at discharge, and monthly for up to 5 months after discharge. Results: For the short-term effects of the therapy, the MAS scores of the elbow and wrist, FMA score, and quality of movement score improved. For the long-term effects of the therapy, the MAS score of the fingers, FMA score, and amount of use score improved for up to 5 months after discharge. Conclusions: The present case report showed the improvement of all assessments performed in the short and/or long term and suggest the possibility of shortening the intervention period of combined therapy of BTX and rTMS with intensive motor training.

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