Early use of Xeomin neurotoxin for local anti-spasticity therapy for pes equines after acquired brain injury (ABI).

This research focuses on the application of Xeomin neurotoxin as a local anti-spasticity treatment for pes equinus (a condition where the foot points downward) that develops after an acquired brain injury. The case study involved a 48-year-old female who had a severe subarachnoid haemorrhage and experienced increasing spasticity in her legs that was not alleviated by traditional therapies. After injection with Xeomin, a significant reduction in spasticity and a gradual improvement in joint mobility was observed, suggesting that Xeomin is an effective early anti-spasticity treatment.

Understanding the Problem

• Spasticity is a common issue following an Acquired Brain Injury (ABI). It causes exaggerated muscle contractions, often making movement uncomfortable and difficult.
• When spasticity occurs in the foot after an ABI, the condition is specifically known as pes equinus, also referred to as drop foot. This can impede the individual’s ability to walk.
• Spasticity is particularly challenging to manage in the acute phases post ABI, with potential for joint contractures to occur.

The Case Study

• The subject was a 48-year-old female who had undergone a severe subarachnoid haemorrhage — a life-threatening type of stroke caused by bleeding on the surface of the brain.
• Despite oral anti-spasticity medication and intensive physiotherapy, the spasticity in her lower limbs worsened, affecting her foot mobility and warranting a more targeted treatment approach.

The Xeomin Neurotoxin Treatment

• Xeomin neurotoxin was used for local anti-spasticity therapy. A total dose of 150 U was injected into the spastic pes equinus.
• Within six days post-injection, a progressive reduction in the patient’s spasticity was observed as assessed by the Modified Ashworth Scale — a measure of muscle tone intensity. The score decreased from 4 to 1-2, signifying decreased spasticity.
• In tandem with the reduced spasticity, an improvement in the patient’s joint mobility was also observed.

Conclusions and Implications

• The study suggests that the early use of Xeomin neurotoxin can be an effective treatment for post-ABI spasticity, particularly for conditions like pes equinus.
• While the cost of Xeomin therapy may initially appear high, the authors argue that it ultimately proves to be cost-efficient in comparison to conservative prolonged treatments.