Treatment of Acquired Deforming Hypertonia with Botulinum Toxin in Older Population: A Retrospective Study
Abstract
:1. Introduction
2. Results
2.1. Population Description
2.2. Follow-Up Time and Survival
2.3. ADH Distribution
2.4. Botulinum Toxin Use
2.5. Goals and Objectives
2.6. Treatment Outcomes
2.7. Questionnaire Survey
3. Discussion
4. Conclusions
5. Materials and Methods
5.1. Population and Data Collection
5.2. Autonomy Assessment
5.3. Data Collection on ADH and Injections
5.4. Prospective Survey
5.5. Evaluation of Treatment Outcomes
5.6. Statistical Analyses
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Age: | Median | Min; Max |
84 | 71; 100 | |
n | % | |
Place of residence: | ||
Community-dwelling | 7 | 17 |
Independent living residence | 7 | 17 |
Nursing home | 12 | 29 |
Long-term care unit | 15 | 37 |
Gender: | ||
Male | 14 | 34 |
Female | 27 | 66 |
Degree of autonomy: | ||
CFS a | 41 | 100 |
CFS 7 or 8 | 37 | 90 |
CFS 6 | 4 | 10 |
GIR b | 25 | 70 |
GIR 1 | 16 | 64 |
GIR 2 | 8 | 32 |
GIR 3 | 1 | 4 |
Comorbidities: | ||
Stroke sequelae | 26 | 63 |
Parkinsonian syndrome | 5 | 12 |
Musculoskeletal disease | 3 | 7 |
Cognitive impairment | 32 | 78 |
Associated cognitive impairment | 21 | 51 |
Isolated cognitive impairment | 11 | 28 |
n | % | |
Lower limb | 27 | 66 |
Hip adductum | 9 | 22 |
Hip flexum | 3 | 7 |
Equinovarus | 3 | 7 |
Knee flexum | 2 | 5 |
Claw toes | 2 | 5 |
Triple lower flexion (Hip + knee + ankle flexion deformity) | 8 | 20 |
Upper limb | 26 | 63 |
Shoulder adductum | 7 | 17 |
Elbow flexum | 3 | 7 |
Closed hand and claw fingers | 12 | 29 |
Triple upper limb flexion (Arm + wrist + finger flexion deformity) | 4 | 10 |
Both lower and upper limb | 4 | 10 |
Associated cervical dystonia | 3 | 7 |
More than one ADH | 21 | 51 |
T1 GAS Score | Make Mobilization Easier (n = 22) | Reduce Pain (n = 32) | Facilitate Hygiene Care and/or Dressing (n = 26) | Improve Skin Complications (n = 19) | Improve Positioning (n = 9) |
−2 | Mobilization with major difficulties or impossible 18% (n = 4) | Pain resistant to conventional analgesics 16% (n = 5) | Complete daily care not possible 19% (n = 5) | Presence of pressure ulcers or moisture-associated skin damage or heal mycosis 10% (n = 2) | Bed positioning uncomfortable, sitting in a chair impossible 66% (n = 6) |
−1 | Easier but very limited mobilization 14% (n = 3) | Reduction in spontaneous, persistent pain during mobilization 28% (n = 9) | Complete daily care difficult but possible 19% (n = 5) | Moderate improvement in pressure ulcers or moisture-associated skin damage or healing of mycoses 26% (n = 5) | Bed positioning more comfortable, sitting in an armchair impossible 11% (n = 1) |
0 | Easier mobilization within target joint amplitudes 45% (n = 10) | 50% pain reduction 31% (n = 10) | Easier and more complete daily care 31% (n = 8) | Healing of pressure ulcers, moisture-associated skin damage or mycoses 47% (n = 9) | Bed positioning comfortable, sitting in a chair possible 11% (n = 1) |
+1 | Mobilizations easier even beyond target joint amplitudes 4% (n = 1) | Improvement allowing a reduction in analgesic treatments 6% (n = 2) | Complete daily care easier than expected 4% (n = 1) | Prolonged sitting possible in an adapted armchair 0% | |
+2 | No discomfort during mobilization 9% (n = 2) | Pain improvement allowing discontinuation of level 2 or 3 analgesics 6% (n = 2) | Normal daily care 4% (n = 1) | Prolonged sitting possible on any seat (chair) 0% | |
Data unavailable * | 10% (n = 2) | 13% (n = 4) | 23% (n = 6) | 16% (n = 3) | 11% (n = 1) |
Mean GAS T1 score | −0.3 | −0.46 | −0.6 | −056 | −1.4 |
Significance of difference between GAS TI and GAS T0 scores | p < 0.0001 | p < 0.0001 | p < 0.0001 | p < 0.0001 | p = 0.5 |
n | % | |
Questionnaire responder: | ||
Total | 14 | 100 |
Patient | 2 | 14 |
Nurse | 8 | 57 |
Primary Care Physician | 2 | 14 |
Designated proxy | 2 | 14 |
Goals targeted: | ||
Reduce Pain | 12 | 86 |
Facilitate daily care | 6 | 43 |
Facilitate mobilization | 6 | 43 |
Improve skin complications | 4 | 28 |
Improve positioning | 1 | 7 |
Treatment impact: | ||
None | 4 | 29 |
Below expectations | 3 | 21 |
Standard performance | 5 | 36 |
Exceeded expectations | 2 | 14 |
Improved quality of life: | ||
Yes, significantly | 2 | 14 |
Yes, moderately | 6 | 43 |
No, not at all | 6 | 43 |
Improved duration or difficulty of daily care: | ||
Yes, significantly | 0 | 0 |
Yes, moderately | 7 | 50 |
No, not at all | 8 | 57 |
Perform the mobilization exercises alone: | ||
Yes | 1 | 7 |
No | 12 | 86 |
I don’t know | 1 | 7 |
Perform the mobilization exercises with other: | ||
Yes | 10 | 71 |
No | 4 | 29 |
Why mobilization exercises were not performed: | ||
Patient refusal | 1 | 7 |
Lack of time | 4 | 29 |
Felt need for repeat injections: | ||
Yes | 5 | 36 |
No | 8 | 57 |
I don’t know | 1 | 7 |
Side effects: | 1 * | 7 |
Benefit rating scale (0 to 10) 1: | 3.78 |
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Maldonado, P.; Bessaguet, H.; Chol, C.; Giraux, P.; Lafaie, L.; Adham, A.; David, R.; Celarier, T.; Ojardias, E. Treatment of Acquired Deforming Hypertonia with Botulinum Toxin in Older Population: A Retrospective Study. Toxins 2024, 16, 365. https://doi.org/10.3390/toxins16080365
Maldonado P, Bessaguet H, Chol C, Giraux P, Lafaie L, Adham A, David R, Celarier T, Ojardias E. Treatment of Acquired Deforming Hypertonia with Botulinum Toxin in Older Population: A Retrospective Study. Toxins. 2024; 16(8):365. https://doi.org/10.3390/toxins16080365
Chicago/Turabian StyleMaldonado, Pablo, Hugo Bessaguet, Cédric Chol, Pascal Giraux, Ludovic Lafaie, Ahmed Adham, Romain David, Thomas Celarier, and Etienne Ojardias. 2024. "Treatment of Acquired Deforming Hypertonia with Botulinum Toxin in Older Population: A Retrospective Study" Toxins 16, no. 8: 365. https://doi.org/10.3390/toxins16080365
APA StyleMaldonado, P., Bessaguet, H., Chol, C., Giraux, P., Lafaie, L., Adham, A., David, R., Celarier, T., & Ojardias, E. (2024). Treatment of Acquired Deforming Hypertonia with Botulinum Toxin in Older Population: A Retrospective Study. Toxins, 16(8), 365. https://doi.org/10.3390/toxins16080365