Peter J. McAllister, Svetlana E. Khatkova, Steven G. Faux, Philippe Picaut, Romain Raymond, Jean-Michel Gracies
New England Institute for Neurology and Headach, 06905 Stamford, USA. E-mail: peter@neinh.com
DOI: 10.2340/16501977-2604

Objective: To compare walking speed in patients with spastic hemiparesis who received abobotulinumtoxinA either in the lower limb or simultaneously in both the lower and upper limbs.
Design: Post hoc analysis from a phase 3 study of abobotulinumtoxinA (Dysport®, NCT01251367).
Patients: Adult patients with spastic hemiparesis causing gait dysfunction.
Methods: Comfortable barefoot walking speed over 10 m was evaluated in patients receiving lower limb vs lower and upper limb injections over ≤4 treatment cycles; 1,000 U or 1,500 U in lower limb for cycle 1/2; optional upper limb injections from cycle 3 (500 U: upper limb, 1,000 U: lower limb).
Results: Mean (standard deviation; SD) lower limb cycle 3/4 doses were lower in the lower plus upper limb group vs lower limb only (1,000 U (SD 50), 1,000 U (SD 50) vs 1,380 U (SD 210), 1,360 U (SD 220). Baseline comfortable barefoot walking speed was similar between groups. Changes at cycle 3 week 4, in m/s, were: lower and upper limb: +0. 063 (SD 0. 131); lower limb only: +0. 078 (SD 0. 114), and cycle 4 week 4: lower and upper limb: +0. 086 (SD 0. 166); lower limb only: +0. 086 (SD 0. 123).
Conclusion: Simultaneous lower and upper limb abobotulinumtoxinA treatment does not hamper improvement in walking speed compared with lower limb treatment alone. Thus, physicians may split the 1,500 U abobotulinumtoxinA dose as needed to best treat patients with spastic paresis.

Spastic hemiparesis is a condition in which the muscles on one side of the body become weak and stiff, often after a stroke. One treatment involves injecting botulinum toxin (e.g. abobotulinumtoxinA) into the affected muscles. Patients may find walking difficult, but repeated injections of abobotulinumtoxinA into the legs have been associated with improved walking speed. How-ever, it is not known whether improvements in walking speed are maintained when the dose of abobotulinumtoxinA is split to treat other affected areas, such as the arms. This study shows that splitting the dose of abobotulinumtoxinA across the arms and legs does not hamper walking speed, compared with injecting into the legs only. This suggests that doctors can split the dose across the arms and legs as needed to best treat the symptoms of spastic hemiparesis.