Junya Yamada

Efficacy of Botulinum Toxin A Treatment for Pes Varus during Gait.

BACKGROUND The efficacy of botulinum toxin A (BoNTA) injection on spasticity is usually measured using Modified Ashworth Scale (MAS), but this only evaluates muscle tone at rest and has poor reliability. There are no reports that quantitatively evaluate pes varus during walking after botulinum treatment. The purpose of this study was to evaluate the efficacy of BoNTA injection on pes varus during gait using 3-dimensional motion analysis. METHODS Twenty-four hemiplegic patients with spastic pes varus deformity during gait received BoNTA injection into lower limb muscles. MAS score, comfortable overground gait velocity, and pes varus angle during treadmill walking were evaluated before, 2, 6, and 12 weeks after the injection. Five healthy subjects were also recruited to develop the pes varus/valgus angle as a normal reference. RESULTS The median MAS scores were significantly lower at 2 and 6 weeks after the injection. The maximum pes varus angle during the swing phase was significantly lower at 2, 6, and 12 weeks after the injection. It was significantly lower at 6 weeks after the injection during stance phase. The comfortable overground gait velocity was also improved after the injection. However, 2 patients experienced pain during gait and their pes varus angle increased during the follow-up period. CONCLUSIONS BoNTA injection improved pes varus angle during gait. Evaluating motion in addition to spasticity at rest is recommended because improvements in limb function do not always parallel improvements in spasticity at rest.

6. Development of a new expression manner of gait using Lissajous figures 2—Application to abnormal gait

The usefulness of the electrophysiological tests on the differentiation of the affected regions (either the nerve root or the anterior horn of the spinal cord) of cervical spondylotic amyotrophy (CSA) was examined on 14 patients with proximal type and 3 patients with distal type CSA. The compound muscle action potentials (CMAP) stimulated at supramaximal Erb point were recorded from the proximal (deltoid and biceps) and distal muscles (extensor digitorum and abductor digiti minimi), and central motor conduction time (CMCT) was calculated from motor evoked potentials and F wave. CMAP was correlated with the manual muscle testing. In distal type CSA patients, decrease in CMAP was observed from both of the distal and the proximal muscles. The delayed CMCT and F wave abnormalities, which suggests the anterior horn legions, were found in 5 proximal and all distal type CSA patients. Furthermore 4 patients with poor prognosis out of 8 operated cases showed the delayed CMCT. Thus, these electrophysiological tests appear to be useful not only to differentiate the affected regions in CSA patients but to predict the prognosis after operation.