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
- Lam, K.; Kwan, J.S.K.; Kwan, C.W.; Chi, I. Factors Associated with Development of New Joint Contractures in Long-Term Care Residents. J. Am. Med. Dir. Assoc. 2022, 23, 92–97. [Google Scholar] [CrossRef] [PubMed]
- Dehail, P.; Gaudreault, N.; Zhou, H.; Cressot, V.; Martineau, A.; Kirouac-Laplante, J.; Trudel, G. Joint Contractures and Acquired Deforming Hypertonia in Older People: Which Determinants? Ann. Phys. Rehabil. Med. 2019, 62, 435–441. [Google Scholar] [CrossRef]
- Dehail, P.; Simon, O.; Godard, A.L.; Faucher, N.; Coulomb, Y.; Schnitzler, A.; Denormandie, P.; Jeandel, C. Acquired Deforming Hypertonia and Contractures in Elderly Subjects: Definition and Prevalence in Geriatric Institutions (ADH Survey). Ann. Phys. Rehabil. Med. 2014, 57, 11–23. [Google Scholar] [CrossRef]
- Wagner, L.M.; Clevenger, C. Contractures in Nursing Home Residents. J. Am. Med. Dir. Assoc. 2010, 11, 94–99. [Google Scholar] [CrossRef] [PubMed]
- Bartoszek, G.; Fischer, U.; Grill, E.; Müller, M.; Nadolny, S.; Meyer, G. Impact of Joint Contracture on Older Persons in a Geriatric Setting: A Cross-Sectional Study. Z. Gerontol. Geriatr. 2015, 48, 625–632. [Google Scholar] [CrossRef] [PubMed]
- Fischer, U.; Müller, M.; Strobl, R.; Bartoszek, G.; Meyer, G.; Grill, E. Prevalence of Functioning and Disability in Older Patients with Joint Contractures: A Cross-Sectional Study. Eur. J. Phys. Rehabil. Med. 2015, 51, 269–279. [Google Scholar]
- Hobbelen, J.S.M.; Koopmans, R.T.C.M.; Verhey, F.R.J.; Van Peppen, R.P.S.; de Bie, R.A. Paratonia: A Delphi Procedure for Consensus Definition. J. Geriatr. Phys. Ther. 2006, 29, 50–56. [Google Scholar] [CrossRef]
- Park, H.K.; Chung, S.J. New Perspective on Parkinsonism in Frontotemporal Lobar Degeneration. J. Mov. Disord. 2013, 6, 1–8. [Google Scholar] [CrossRef] [PubMed]
- Tosto, G.; Monsell, S.E.; Hawes, S.E.; Mayeux, R. Pattern of Extrapyramidal Signs in Alzheimer’s Disease. J. Neurol. 2015, 262, 2548–2556. [Google Scholar] [CrossRef]
- Hobbelen, J.S.M.; Tan, F.E.S.; Verhey, F.R.J.; Koopmans, R.T.C.M.; de Bie, R.A. Prevalence, Incidence and Risk Factors of Paratonia in Patients with Dementia: A One-Year Follow-up Study. Int. Psychogeriatr. 2011, 23, 1051–1060. [Google Scholar] [CrossRef]
- Vahia, I.; Cohen, C.I.; Prehogan, A.; Memon, Z. Prevalence and Impact of Paratonia in Alzheimer Disease in a Multiracial Sample. Am. J. Geriatr. Psychiatry 2007, 15, 351–353. [Google Scholar] [CrossRef] [PubMed]
- Trudel, G.; Uhthoff, H.K.; Brown, M. Extent and Direction of Joint Motion Limitation after Prolonged Immobility: An Experimental Study in the Rat. Arch. Phys. Med. Rehabil. 1999, 80, 1542–1547. [Google Scholar] [CrossRef]
- Hacker, M.L.; Ploucher, S.; Naik, A.G.; Turchan, M.; Meystedt, J.C.; Harper, K.; Hedera, P.; Pirtle, C.J.; Stubblefield, K.; Charles, D. A Simple Bedside Screening Tool for Spasticity Referral. Clin. Interv. Aging 2020, 15, 655–662. [Google Scholar] [CrossRef]
- Lam, K.; Wong, D.; Tam, C.K.; Wah, S.H.; Myint, M.W.W.J.; Yu, T.K.K.; So, K.K.; Cheung, G.; Au, K.M.; Fu, M.H.; et al. Ultrasound and Electrical Stimulator-Guided Obturator Nerve Block With Phenol in the Treatment of Hip Adductor Spasticity in Long-Term Care Patients: A Randomized, Triple Blind, Placebo Controlled Study. J. Am. Med. Dir. Assoc. 2015, 16, 238–246. [Google Scholar] [CrossRef]
- Karri, J.; Mas, M.F.; Francisco, G.E.; Li, S. Practice Patterns for Spasticity Management with Phenol Neurolysis. J. Rehabil. Med. 2017, 49, 482–488. [Google Scholar] [CrossRef] [PubMed]
- Brunet, F.; Schwald, N.; Sehaba, A.; Coulomb, Y.; Henry, O. Efficacité de l’alcoolisation du nerf obturateur dans l’hypertonie des adducteurs chez la personne âgée hospitalisée: Étude préliminaire. NPG Neurol. Psychiatr. Gériatrie 2019, 19, 221–226. [Google Scholar] [CrossRef]
- Bessaguet, H.; Calmels, P.; Schnitzler, A.; Coroian, F.; Giraux, P.; Angioni, F.; Adham, A.; Denormandie, P.; David, R.; Ojardias, E. Percutaneous Needle Tenotomies: Indications, Procedures, Efficacy and Safety. A Systematic Review. Ann. Phys. Rehabil. Med. 2024, 67, 101839. [Google Scholar] [CrossRef]
- Chol, C.; Blanchon, M.-A.; Le Quang, B.; Celarier, T.; Gonthier, R. Botulinum toxin in the elderly to the care of limbs spastic hypertonia and toes or fingers dystonias. Geriatr. Psychol. Neuropsychiatr. Vieil. 2012, 10, 17–26. [Google Scholar] [CrossRef] [PubMed]
- Datta Gupta, A.; Eyre, R. Role of Botulinum Toxin in the Management of Hand Ulceration Due to Post-Stroke Spasticity among Aged Care Residents. Aust. J. Gen. Pract. 2022, 51, 484–489. [Google Scholar] [CrossRef]
- Lam, K.; Lau, K.K.; So, K.K.; Tam, C.K.; Wu, Y.M.; Cheung, G.; Liang, K.S.; Yeung, K.M.; Lam, K.Y.; Yui, S.; et al. Can Botulinum Toxin Decrease Carer Burden in Long Term Care Residents with Upper Limb Spasticity? A Randomized Controlled Study. J. Am. Med. Dir. Assoc. 2012, 13, 477–484. [Google Scholar] [CrossRef]
- Haute Autorité de Santé (HAS). Les Anticoagulants Oraux; Saint-Denis La Plaine. 2018. Available online: https://www.has-sante.fr/jcms/c_2851086/fr/les-anticoagulants-oraux (accessed on 14 July 2024).
- Ble, O.; Bensmail, D.; Pérennou, D.; Parratte, B.; Joseph, P.-A.; Boyer, F.-C.; Michelon, H.; Lansaman, T.; Levy, J. Management of Antithrombotics for Intramuscular Injection of Botulinum Toxin for Spasticity. A Survey of Real-Life Practice in France. Ann. Phys. Rehabil. Med. 2021, 64, 101467. [Google Scholar] [CrossRef]
- Levy, J.; Karam, P.; Forestier, A.; Loze, J.-Y.; Bensmail, D. Botulinum Toxin Use in Patients with Post-Stroke Spasticity: A Nationwide Retrospective Study from France. Front. Neurol. 2023, 14, 1245228. [Google Scholar] [CrossRef] [PubMed]
- Edwards, L.; Ellis, B.; Donnellan, C.; Osman, H.; Haboubi, N.; Jones, M.; Sunman, W.; Pinnington, L.; Phillips, M.F. Prevalence of Unmet Needs for Spasticity Management in Care Home Residents in the East Midlands, United Kingdom: A Cross-Sectional Observational Study. Clin. Rehabil. 2019, 33, 1819–1830. [Google Scholar] [CrossRef] [PubMed]
- Médina, M. Utilisation de la Toxine Botulique dans la Prise en Charge de la Spasticité des Personnes âgées. 2014. Available online: https://dumas.ccsd.cnrs.fr/dumas-01068753v1/file/Med_generale_2014_Medina.pdf (accessed on 14 July 2024).
- Guilhermet, Y.; Valdelièvre, L.; Krolak-Salmon, P. L’AVC du sujet âgé: Vers une prise en charge spécialisée à la phase aiguë et en SSR? Les Cahiers de l’année Gérontologique 2010, 2, 97–103. [Google Scholar] [CrossRef]
- Angioni, F.; Salga, M.; Denormandie, P.; Genêt, F.; Haigh, O.; David, R.; Gatin, L.; Schnitzler, A. Microinvasive Percutaneous Needle Tenotomy, An Alternative to Open Surgery to Treat Neurological Foot Deformities. Ann. Phys. Rehabil. Med. 2022, 66, 101690. [Google Scholar] [CrossRef]
- Kleiner-Fisman, G.; Khoo, E.; Moncrieffe, N.; Forbell, T.; Gryfe, P.; Fisman, D. A Randomized, Placebo Controlled Pilot Trial of Botulinum Toxin for Paratonic Rigidity in People with Advanced Cognitive Impairment. PLoS ONE 2014, 9, e114733. [Google Scholar] [CrossRef]
- Schnitzler, A.; Dince, C.; Freitag, A.; Iheanacho, I.; Fahrbach, K.; Lavoie, L.; Loze, J.-Y.; Forestier, A.; Gasq, D. AbobotulinumtoxinA Doses in Upper and Lower Limb Spasticity: A Systematic Literature Review. Toxins 2022, 14, 734. [Google Scholar] [CrossRef]
- Ojardias, E.; Ollier, E.; Lafaie, L.; Celarier, T.; Giraux, P.; Bertoletti, L. Time Course Response after Single Injection of Botulinum Toxin to Treat Spasticity after Stroke: Systematic Review with Pharmacodynamic Model-Based Meta-Analysis. Ann. Phys. Rehabil. Med. 2022, 65, 101579. [Google Scholar] [CrossRef]
- Rosales, R.L.; Arimura, K.; Takenaga, S.; Osame, M. Extrafusal and Intrafusal Muscle Effects in Experimental Botulinum Toxin-A Injection. Muscle Nerve 1996, 19, 488–496. [Google Scholar] [CrossRef]
- Ishikawa, H. Presynaptic Effects of Botulinum Toxin Type A on the Neuronally Evoked Response of Albino and Pigmented Rabbit Iris Sphincter and Dilator Muscles. Jpn. J. Ophthalmol. 2000, 44, 106–109. [Google Scholar] [CrossRef]
- McMahon, H.T.; Foran, P.; Dolly, J.O.; Verhage, M.; Wiegant, V.M.; Nicholls, D.G. Tetanus Toxin and Botulinum Toxins Type A and B Inhibit Glutamate, Gamma-Aminobutyric Acid, Aspartate, and Met-Enkephalin Release from Synaptosomes. Clues to the Locus of Action. J. Biol. Chem. 1992, 267, 21338–21343. [Google Scholar] [CrossRef] [PubMed]
- Popescu, M.N.; Beiu, C.; Iliescu, M.G.; Mihai, M.M.; Popa, L.G.; Stănescu, A.M.A.; Berteanu, M. Botulinum Toxin Use for Modulating Neuroimmune Cutaneous Activity in Psoriasis. Medicina 2022, 58, 813. [Google Scholar] [CrossRef] [PubMed]
- Match ID. National Public Death Database. Available online: https://deces.matchid.io/search (accessed on 26 April 2024).
- Benaim, C.; Froger, J.; Compan, B.; Pélissier, J. Évaluation de l’autonomie de la personne âgée. Ann. De Réadaptation Et De Médecine Phys. 2005, 48, 336–340. [Google Scholar] [CrossRef] [PubMed]
- Dent, E.; Kowal, P.; Hoogendijk, E.O. Frailty Measurement in Research and Clinical Practice: A Review. Eur. J. Intern. Med. 2016, 31, 3–10. [Google Scholar] [CrossRef] [PubMed]
- Turner-Stokes, L. Goal Attainment Scaling (GAS) in Rehabilitation: A Practical Guide. Clin. Rehabil. 2009, 23, 362–370. [Google Scholar] [CrossRef] [PubMed]
- Bard-Pondarré, R.; Villepinte, C.; Roumenoff, F.; Lebrault, H.; Bonnyaud, C.; Pradeau, C.; Bensmail, D.; Isner-Horobeti, M.-E.; Krasny-Pacini, A. Goal Attainment Scaling in Rehabilitation: An Educational Review Providing a Comprehensive Didactical Tool Box for Implementing Goal Attainment Scaling. J. Rehabil. Med. 2023, 55, jrm6498. [Google Scholar] [CrossRef] [PubMed]
- Kiresuk, T.J.; Smith, A.; Cardillo, J.E. (Eds.) Goal Attainment Scaling: Applications, Theory, and Measurement; L. Erlbaum Associates: Hillsdale, NJ, USA, 1994; ISBN 978-0-89859-889-6. [Google Scholar]
- Krasny-Pacini, A.; Hiebel, J.; Pauly, F.; Godon, S.; Chevignard, M. Goal Attainment Scaling in Rehabilitation: A Literature-Based Update. Ann. Phys. Rehabil. Med. 2013, 56, 212–230. [Google Scholar] [CrossRef]
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