Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged Patients
Spasticity is a common complication in patients with neurological disorders, increasing disability and hampering quality of life. Combined treatment with focused shock waves (fESWT) and botulinum toxin (BoNT-A) has been shown to increase the effectiveness and duration of the effect of BoNT-A on spas...
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MDPI AG
2025-04-01
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| author | Antonio Déniz Pedro Saavedra Isabel Marrero Samuel Barrera Raúl Domínguez Raúl Mendoza Jorge Rodríguez |
| author_facet | Antonio Déniz Pedro Saavedra Isabel Marrero Samuel Barrera Raúl Domínguez Raúl Mendoza Jorge Rodríguez |
| author_sort | Antonio Déniz |
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| description | Spasticity is a common complication in patients with neurological disorders, increasing disability and hampering quality of life. Combined treatment with focused shock waves (fESWT) and botulinum toxin (BoNT-A) has been shown to increase the effectiveness and duration of the effect of BoNT-A on spasticity in patients with brain injuries. We studied the effectiveness of the combination of unfocused shock waves (uESWT) and BoNT-A on spasticity. This prospective study with systematic randomization included 24 patients with brain injury, a small sample size due to clinical limitations, and spasticity was measured using the Ashworth scale (AS) for those with lower limb involvement; gait speed was assessed using the 10-m gait test (10MWT). To judge patient satisfaction with treatment, we used the Consumer Reports Effectiveness Scale-4 (CRES-4). Both uESWT and fESWT with BoNT-A resulted in a 3-point improvement in the median spasticity score, which was maintained from week 2 to week 26, and a statistically significant reduction in the 10MWT was observed. Furthermore, the proportion of patients who were very satisfied with the treatment was higher with uESWT (91%) than with fESWT (69.2%). To the authors’ knowledge, this is the first study to evaluate the added benefit of concurrent and combined treatment with uESWT and BoNT-A injections to improve spasticity in patients with stroke or multiple sclerosis and show higher patient satisfaction with the treatment. |
| format | Article |
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| institution | Kabale University |
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| spelling | doaj-art-b5d949a9f0ce4593a0e7708edc95b2e62025-08-20T03:47:54ZengMDPI AGToxins2072-66512025-04-0117520910.3390/toxins17050209Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged PatientsAntonio Déniz0Pedro Saavedra1Isabel Marrero2Samuel Barrera3Raúl Domínguez4Raúl Mendoza5Jorge Rodríguez6Neurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr. Negrín, 35010 Las Palmas, SpainDepartment of Mathematics, University of Las Palmas de Gran Canaria, 35017 Las Palmas, SpainPhysiology, Department of Biochemistry and Molecular Biology, University of Las Palmas de Gran Canaria, 35016 Las Palmas, SpainNeurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr. Negrín, 35010 Las Palmas, SpainNeurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr. Negrín, 35010 Las Palmas, SpainNeurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr. Negrín, 35010 Las Palmas, SpainNeurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr. Negrín, 35010 Las Palmas, SpainSpasticity is a common complication in patients with neurological disorders, increasing disability and hampering quality of life. Combined treatment with focused shock waves (fESWT) and botulinum toxin (BoNT-A) has been shown to increase the effectiveness and duration of the effect of BoNT-A on spasticity in patients with brain injuries. We studied the effectiveness of the combination of unfocused shock waves (uESWT) and BoNT-A on spasticity. This prospective study with systematic randomization included 24 patients with brain injury, a small sample size due to clinical limitations, and spasticity was measured using the Ashworth scale (AS) for those with lower limb involvement; gait speed was assessed using the 10-m gait test (10MWT). To judge patient satisfaction with treatment, we used the Consumer Reports Effectiveness Scale-4 (CRES-4). Both uESWT and fESWT with BoNT-A resulted in a 3-point improvement in the median spasticity score, which was maintained from week 2 to week 26, and a statistically significant reduction in the 10MWT was observed. Furthermore, the proportion of patients who were very satisfied with the treatment was higher with uESWT (91%) than with fESWT (69.2%). To the authors’ knowledge, this is the first study to evaluate the added benefit of concurrent and combined treatment with uESWT and BoNT-A injections to improve spasticity in patients with stroke or multiple sclerosis and show higher patient satisfaction with the treatment.https://www.mdpi.com/2072-6651/17/5/209extracorporeal shock wave therapyfocal shock wavesunfocused shock wavesbotulinum toxin type Aspasticitystroke |
| spellingShingle | Antonio Déniz Pedro Saavedra Isabel Marrero Samuel Barrera Raúl Domínguez Raúl Mendoza Jorge Rodríguez Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged Patients Toxins extracorporeal shock wave therapy focal shock waves unfocused shock waves botulinum toxin type A spasticity stroke |
| title | Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged Patients |
| title_full | Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged Patients |
| title_fullStr | Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged Patients |
| title_full_unstemmed | Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged Patients |
| title_short | Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged Patients |
| title_sort | effectiveness of unfocused vs focal shock waves combined with botulinum toxin on spasticity in brain damaged patients |
| topic | extracorporeal shock wave therapy focal shock waves unfocused shock waves botulinum toxin type A spasticity stroke |
| url | https://www.mdpi.com/2072-6651/17/5/209 |
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