EFFECT OF INTRATHECAL BACLOFEN, BOTULINUM TOXIN TYPE A AND A REHABILITATION PROGRAMME ON LOCOMOTOR FUNCTION AFTER SPINAL CORD INJURY A CASE REPORT

Objective A few studies has reported the use of botulinum toxin injections after spinal cord injury as this is the gold standard to treat focal spasticity We report such a case here Case report A 38 year-old woman who had become para plegic and care dependent secondary to cervico thoracic in tramedullary ependymoma, presented 8 months later painful lower limb spasticity which was being treated with oral anti spastic and benzodizepine drugs with no therapeutic effect We treated the patient with intrathecal baclofen to reduce her spasticity and in order to avoid the major side effects of high dosages of oral baclofen After motor rehabilitation programmes which included functional electrical stimulation, the patient was able to wear in advanced reciprocating gait orthosis However, she experienced pain ful muscle spasms in her toes of the feet that limited her gait Therefore, she was also treated with bilateral injections of botulinum toxin type A into the flexor digitorum brevis muscles The patient reported relief of spasms and pain, enabling her to wear in advanced reciprocating gait orthosis and facilitating rehabilitation programmes Conclusion The use of botulinum toxin type A may be an important adjunctive therapy to increase the therapeutic ef fect of baclofen on spasticity in small muscles, resulting in a more focal effect, and improving the use of orthoses and the effectiveness of rehabilitation programmes in patients after spinal cord injury