Botulinum toxin type A in the healing of a chronic buttock ulcer in a patient with spastic paraplegia after spinal cord injury

paraplegia. Case report: A 27-year-old man with spastic paraplegia following traumatic spinal cord lesion at the thoracic level had developed recurrent severe muscular spasms, particularly involving the buttock region, with an Ashworth scale score of 3–4 and a Spasm Frequency Scale of grade 4. The patient had a pressure ulcer in the left gluteal region (grade IV according to the European Pressure Ulcer Advisory Panel (EPUAP). Several treatments were administered without success, and all efforts at healing the ulcer by topical medication were hampered by recurrent spasms involving the buttock muscles and ulcer region. The left gluteus maximus muscle was treated with 2 infiltrations of 660 IU botulinum toxin type A. The use of botulinum toxin type A allowed better care of the pressure ulcer, which had healed by 6 months after the initial infiltration. Conclusion: The use of botulinum toxin type A may be an important adjunctive therapy for treatment of pathological conditions involving recalcitrant involuntary muscle contraction

Botulinum toxin type A in the healing of ulcer following oro-mandibular dyskinesia in a patient in a vegetative state

OBJECTIVE: Use of botulinum toxin is expanding as clinical studies demonstrate new potential therapeutic applications. In rehabilitation, botulinum toxin is predominantly used as adjunct therapy for the treatment of spasticity, but it may prove useful for other atypical clinical situations. CASE HISTORY: A 73-year-old man had a severe sub-arachnoid haemorrhage following the rupture of a giant aneurism of the middle left cerebral artery. Clinically, the patient presented a vegetative state and an oro-mandibular dyskinesia that produced a chronic ulcer on the lower lip. As treatment for this dyskinesia, a total of 320 U botulinum toxin type A were injected into the upper and lower orbicularis oris and masseter muscles. RESULTS AND DISCUSSION: This treatment allowed for application of topical medication and subsequently, ulcer healing. Botulinum toxin type A may be an important therapeutic aid for clinicians faced with treating persistent pathological conditions caused by dyskinesi

Functional outcome and health status of injured patients with peripheral nerve lesions.

BACKGROUND: Peripheral nerve lesions (PNLs) can complicate the clinical course and outcome of multiply injured patients. Since this often impedes recovery, it can be a significant burden for both patients and clinicians. The objective of the present study was to investigate the long-term outcome and health status of patients with PNL. SUBJECTS AND METHODS: Multiply injured patients admitted to an intensive rehabilitation setting were identified. The Barthel and modified Rankin scales (mRS) were administered to all patients at admission, discharge and follow-up. The short form (SF)-36 questionnaire was used at follow-up (mean: 25.3+/-6.5 months). RESULTS: Seventy-seven multiply injured patients were identified, and 45 (22 male, 23 female; mean age: 59.7+/-21.7 years; range: 19-83 years) were enrolled. Of the injured patients, 22 subjects (10 male and 12 female) had no PNL, while 23 (12 male, 11 female) did. In the PLN group, the mean Barthel scores at admission, discharge and follow-up, respectively, were 33.4+/-17.9, 85.3+/-3.8 and 93.0+/-6.9 (p<0.001) and the median mRS scores were 4 (interquartile range (IQR): 3-5), 3 (IQR: 1-3) and 1 (IQR: 0-2), respectively. In the group without PLN, the mean Barthel scores at admission, discharge and follow-up, respectively, were 30.4+/-14.5, 86.6+/-9.8 and 96.6+/-4.9 (p<0.001) and the median mRS scores were 4 (IQR: 3-5), 2 (IQR: 1-3) and 0.5 (IQR: 0-2). The mean length of hospital stay was 86.7+/-10.8 and 65.6+/-14.6 days in patients with and without PNL, respectively. The SF-36 did not show significant differences between the groups, but the patients with and without PNL reported significant lower mean scores on all items compared to national population norms. CONCLUSION: Multiply injured patients with and without PNL showed significant improvement and a good long-term outcome after rehabilitation. However, those with PNL had a longer hospital stay and needed more rehabilitation than patients without PNL. Both the groups of patients experienced significant difficulties in the health status