Investigation of the effect of oral baclofen and botulinum toxin injections on electromyographic nociceptive flexor reflex threshold in hemiplegic patients

Objective: Spasticity is defined as an increased rate-dependent resistance to passive movements related to the occurrence of hyperactive reflexes after upper motor neuron lesions (1). The hemiplegia chart after apoplexy brings out many problems. Spasticity is one of these problems. Systemic medicine therapy (baclofen, diazepam, dantrolene and tizanidine) or local therapy (botulinum toxin, phenol injection) can be used in the treatment of spasticity. The aim of our study; to investigate the effect of oral baclofen and botulinum toxin injections on electromyographic nociceptive flexor reflex (NFR) threshold in hemiplegic patients with spasticity. Methods: 29 spastic hemiplegia patients who applied to the Physical Medicine and Rehabilitation outpatient clinic of Hatay Mustafa Kemal University Medical Faculty Research and Application Hospital participated in the study. After the patients had been randomized a group of them were applied a treatment of botulinum toxin injection, but the other group a treatment of to oral baclofen. Both groups were evaluated at the beginning and at the end of the 6th week treatment. The evaluation was performed according to the patients' modified ashworth scale (MAS), visual analog scale (VAS), brunnstrom staging, barthel daily life activity index and NFR threshold values. Results: MAS, VAS values decreased significantly compared to pretreatment (p<0.05) in spastic hemiplegic patients who accepted BT-A and baclofen in both groups. Ankle MAS values were observed significantly lower in BT-A patients than in baclofen patients (p<0.05). Brunnstrom hand staging was significantly increased at the 6th week of treatment (p<0.05) in the BT-A group. The NFR threshold was significantly higher in the baclofen group compared to pretreatment (p=0.007). There was no statistically significant change in NFR threshold in the BT-A group (p=0.669). Conclusion: This study showed that BT-A and baclofen applied for the treatment in spastic hemiplegic patients made significant contributions to healing. While baclofen can cause a significant increase in the NFR threshold, it can be said that BT-A administration does not change this threshold much. Key Words: Hemiplegia, spasticity, nociceptive flexor reflex, botulinum toxin-A, baclofen