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Background. TXB-A injections are the first-line treatment of many movement disorders, and the safety of doing them is essential to the effectiveness of therapy. Aims. Evaluation of safety of TXB-A guided injections in upper limb spasticity of post-stroke patients. Methods. The study group comprised 60 patients distributed in 3 subgroups of 20 based on background medication administered in post-stroke management: 20 patients in the antiplatelet background subgroup, 20 patients in the subgroup of anticoagulant background medication, and 20 without anticoagulant/antiplatelet background medication. From the 60 patient group, based on the number of TXB-A injection cycles, 3 other subgroups were produced: 20 patients performed 3 injection cycles, 20 performed 2 cycles, and 20 completed a single injection cycle. Every patient received a total dose of 1000 UI of TXB-A. After each set of local injections, ultrasounds were performed at the injection site searching for local hematomas. The moments evaluated were: T0 (the initial time - injection time), T1 (one month after the injection), T2 (3 months from T0 or 2 months from T1), T3 (1 month after T2), T4 (3 months after T2 or 2 months after T3) and T5 (1 month after T4). Results. The lowest p value of the 3 possible comparisons of the anticoagulant, antiplatelet, no anticoagulant/antiplatelet group of patients was 0.856, showing a purely random distribution of adverse effects manifested by local hematomas following ultrasound guided injections. Conclusions. Multiple cycles of US guided TXB-A injections with a minimum 3-month frequency between injections do not increase the risk of local haematomas. [ABSTRACT FROM AUTHOR]

Background. Spasticity is well known as one of the most common after stroke complications, providing a series of negative effects including decreased range of motion, muscle spasm, different levels of contracture, local pain in the affected area. Aims. Clinical-functional evaluation of the short and medium term effect of ultrasonographically guided injections with botulinum toxin type A (TxB-A) on the spasticity of the upper limb in post-stroke patients and the quantification of effects on international scales of spasticity and functionality. Methods. The groups studied were composed of 60 patients, which were divided based on the doses provided in each muscle of the hand and wrist flexors (250 IU versus 333 IU). Every patient received a total dose of 1000 IU of TxB-A. The parameters that were assessed were: Modified Ashworth Scale (MAS) and Activities of Daily Living Scale (ADL), international scales for spasticity and functionality. The moments evaluated were: T0 (the initial time - injection time), T1 (one month after the injection) and T2 (3 months from T0 or 2 months from T1). Results. Evaluation of MAS and ADL scales from T0 to T1 and T2 for the 250 IU group shows great improvements at T1 on both scales, MAS (<0.001) and ADL (<0.001), while maintaining the efficacy at T2, MAS (p-value 0.214 ), ADL (p-value 0.166). Evaluation of MAS and ADL scales from T0 to T1 and T2 for the 333 IU group also shows effective improvements on both scales at T1, MAS (<0.001), ADL (<0.001), and T2, MAS (0.849), ADL (0.013). Correlations between the two groups, 250 IU vs 333 IU, performed for each of the scales used in the study evidenced better results at T1 in favor of the 333 IU group on both MAS (p-value 0.034) and ADL score (p-value 0.078), with the proportion maintained in favor of the 333 IU group at T2, MAS (p-value 0.024), ADL (p-value 0.035). Conclusions. a) TxB-A is efficient as a prime line treatment for spasticity, helping the patients in the muscle neurorehabilitation effort; b) TxB A is effective in reducing spastic muscle tone (MAS); c) TxB A is a useful asset in managing hand function (ADL). [ABSTRACT FROM AUTHOR]