Low-dose botulinum toxin with short-term electrical stimulation in poststroke spastic drop foot - A preliminary study

Objective: To compare low-dose botulinum toxin injections followed by short-term electrical stimulation with high-dose botulinum toxin for poststroke spastic drop foot. Design: Twelve patients with spastic drop foot were randomly assigned to two treatment groups. The first group (n = 6) received low-dose (100 Units) botulinum toxin injection to the posterior tibial muscle in combination with short-term electrical stimulation, and the second group (n = 6) received a total of 400 units of botulinum toxin injections in equal doses to the posterior tibial, soleus, medial, and lateral gastrocnemius muscles. The patients were evaluated before and 2, 4, 8, and 12 wks after the treatment by the following variables: resting position angle, active and passive ankle range of motion, Modified Ashworth Scale, time walking 10 m, clonus score, Brace Wear Scale, and Global Assessment of Spasticity Scale. Results: Improvement was recorded in both groups for all variables except brace wear. No significant difference was found between the study groups after treatment. The effects lasted shorter in the first group, whereas more side effects were seen in the second group. Conclusions: Our preliminary single-blind study was unable to find a difference in terms of effectiveness between low-dose (100 units) botulinum toxin combined with short-term electrical stimulation and high-dose (400 units) application in spastic drop foot.