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This article and any supplementary material should be cited as follows: Wilkenfeld AJ. Review of electrical stimulation, botulinum toxin, and their combination.

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Presentation on theme: "This article and any supplementary material should be cited as follows: Wilkenfeld AJ. Review of electrical stimulation, botulinum toxin, and their combination."— Presentation transcript:

1 This article and any supplementary material should be cited as follows: Wilkenfeld AJ. Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot. J Rehabil Res Dev. 2013;50(3):315-26. http://dx.doi.org/10.1682/JRRD.2012.03.0044 Slideshow Project DOI:10.1682/JRRD.2012.03.0044JSP Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot Ari Jacob Levi Wilkenfeld, MD, PhD

2 This article and any supplementary material should be cited as follows: Wilkenfeld AJ. Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot. J Rehabil Res Dev. 2013;50(3):315-26. http://dx.doi.org/10.1682/JRRD.2012.03.0044 Slideshow Project DOI:10.1682/JRRD.2012.03.0044JSP Aim – Review pathophysiology of spastic drop foot and its treatment options. – Present theoretical reasons why functional electrical stimulation (ES) and botulinum toxin (BTX) injections could work synergistically. Relevance – There are reasons to think functional ES and BTX injections might work effectively in combination, but no clear consensus exists in literature.

3 This article and any supplementary material should be cited as follows: Wilkenfeld AJ. Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot. J Rehabil Res Dev. 2013;50(3):315-26. http://dx.doi.org/10.1682/JRRD.2012.03.0044 Slideshow Project DOI:10.1682/JRRD.2012.03.0044JSP Background Spastic drop foot – Weak ankle dorsiflexors and spastic ankle plantar flexors predispose ankle to stay pathologically plantar flexed. Functional ES – Uses electric current to activate muscles and nerves that are weak/paralyzed but still have intact lower motor neurons and musculature. BTX – Prevents acetylcholine release at presynaptic terminal, thus impairing neuromuscular transmission and inducing weakness.

4 This article and any supplementary material should be cited as follows: Wilkenfeld AJ. Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot. J Rehabil Res Dev. 2013;50(3):315-26. http://dx.doi.org/10.1682/JRRD.2012.03.0044 Slideshow Project DOI:10.1682/JRRD.2012.03.0044JSP Treatment 4 mechanisms by which ES might increase antispasticity effect of BTX. – Animal experiments: BTX’s paralytic effect starts earlier when toxin uptake is increased with ES. – Moving muscle through flexion/extension cycles could help mechanically spread toxin. – Direct effects of ES on tone reduction. – Simultaneously addressing positive and negative components of upper motor neuron syndrome could lead to increased functional gains in gait.

5 This article and any supplementary material should be cited as follows: Wilkenfeld AJ. Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot. J Rehabil Res Dev. 2013;50(3):315-26. http://dx.doi.org/10.1682/JRRD.2012.03.0044 Slideshow Project DOI:10.1682/JRRD.2012.03.0044JSP Conclusions For ES: Evidence of decreased spasticity. – But, e.g., whether stimulation should be over spastic muscle or its antagonist, how long effect lasts, and whether it works during gait must be clarified. For BTX: Evidence of decreased tone. – But evidence lacking for improved gait. ES+BTX: Evidence that ES of muscle may increase efficacy of BTX. – However, large controlled studies examining relative effects are lacking.

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