Combined effects of botulinum toxin type A and repetitive transcranial magnetic stimulation with intensive motor training immediately after injection in a patient with chronic stroke: A case report

• Published in: Journal of hand therapy 2019-10, Vol.32 (4), p.519-524
• Main Authors: Hirakawa, Yuichi, Koyama, Soichiro, Tanabe, Shigeo, Takeda, Kazuya, Ueda, Tetsuya, Motoya, Ikuo, Sakurai, Hiroaki, Kanada, Yoshikiyo, Kawamura, Nobutoshi, Kawamura, Mami, Nagata, Junji, Kanno, Tetsuo
• Format: Article
• Language: English
• Subjects: Activities of daily living; Botulinum toxin; Botulinum toxin type A; Botulinum Toxins, Type A - therapeutic use; Case reports; Combined Modality Therapy; Combined treatment; Discharge; Elbow; Electromyography; Hemorrhage; Human motion; Humans; Injection; Injections, Intramuscular; Long-term effects; Magnetic fields; Male; Middle Aged; Motor activity; Muscle Spasticity - physiopathology; Muscle Spasticity - therapy; Muscles; Neuromuscular Agents - therapeutic use; Patients; Rehabilitation; Repetitive transcranial magnetic stimulation; Spasticity; Stroke; Stroke - physiopathology; Stroke Rehabilitation - methods; Therapy; Toxins; Training; Transcranial Magnetic Stimulation; Upper Extremity - physiopathology; Wrist
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2018.01.008

Single case report. A previous study clarified that spasticity and motor function were improved by combined treatment with botulinum toxin type A (BTX) injection and 1-Hz repetitive transcranial magnetic stimulation (rTMS) with intensive motor training at 4 weeks after injection. However, it is not clear whether 1-Hz rTMS with intensive motor training immediately after BTX injection also improves spasticity and motor function in stroke patients. The purpose of this case report is to test the short- and long-term effects of BTX injection and rTMS with intensive motor training on the spasticity, motor function, and usefulness of the paretic hand in a stroke patient. A 64-year-old male, who suffered from a right cerebral hemorrhage 53 months previously, participated in the present study. BTX was injected into the spastic muscles of the affected upper limb. He then received the new protocol for a total of 24 sessions. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Activity Log, consisting of the amount of use and quality of movement scales, were assessed before and immediately after BTX injection, at discharge, and monthly for up to 5 months after discharge. For the short-term effects of the therapy, the MAS scores of the elbow and wrist, FMA score, and quality of movement score improved. For the long-term effects of the therapy, the MAS score of the fingers, FMA score, and amount of use score improved for up to 5 months after discharge. The present case report showed the improvement of all assessments performed in the short and/or long term and suggest the possibility of shortening the intervention period of combined therapy of BTX and rTMS with intensive motor training. •1-Hz repetitive transcranial magnetic stimulation with rehabilitation immediately after botulinum toxin type A injection in a stroke patient.•The spasticity, motor function, and usefulness of the paretic hand improved.•This is a possibility of shortening the intervention period of combined therapy.