A Letter Released to Physicians on April 4, 2006

Botox Treatments Now Available to Your Stroke Patients in Charlotte Area

Dear colleague, this is an open letter to announce the availability of botulinum toxin A (BTX-A) treatments for post-stroke spasticity in our area. I am Dr. Neal Taub, ABPM&R. In addition to serving as the Medical Director at Carolinas Rehabilitation at Mercy, I practice privately from my office on Randolph Rd. In my private physiatry practice, I have experienced encouraging results with the BTX-A therapy. I invite you to refer your patients struggling with spasticity after a stroke for evaluation and treatment at my private physiatry practice.

Researchers say that up to 30% of stroke survivors suffer from disabling muscle spasticity. As you have probably seen, spasticity in the upper extremities hinders a person’s ability to dress, feed themselves, or practice personal hygiene. In the lower extremities, spasticity impairs gait and the ability to transfer. If spasticity is not managed correctly, it can result in disabling complications such as permanent contractures. Timely intervention with effective therapies is vital to prevent the profound disability that afflicts many stroke patients. Effective therapy for post-stroke muscle spasticity, even in prolonged cases, can lessen the emotional toll on caregivers and lessen the financial burden on the health care system as a whole.

You may have recently read about the promising alternative of BTX-A treatments in journals such as the New England Journal of Medicine, Neurology, Journal of Rehabilitative Medicine, Drugs & Aging, or Clinical Rehabilitation. The treatment involves BTX-A injections into problematic muscles. The treatment usually requires identification and precise injection of small muscles of the hands and/or lower extremities. BTX-A treatments have proven very effective at quickly reducing spasticity. Effects from just one treatment have been shown to last 12 to 24 weeks (see reverse for references).¹ Up to 50% of patients in various trials have realized functional gains such as improvement in:

• pain²
• ambulation^2,5
• limb position1
• arm and grip strength³
• advanced hand function⁴
• balance⁵
• independent personal hygiene tasks^1,2
• dressing

In the coming months, I will send you more bulletins about this important treatment option for your stroke patients. In addition, I would be very happy to visit your office personally to discuss this promising treatment. Please note that my private practice focuses on physical medicine, rehabilitation, and electromyography. I provide neither primary care nor surgery. Patients you refer to my practice will primarily receive focused assessments and treatments specific for the referral complaint.

If you have patients suffering from post-stroke spasticity, please tell them about me, Neal S. Taub, MD, physiatrist.

References

1. Brashear A, Gordon M, Elovic E. “Intramuscular Injection of Botulinum Toxin for the Treatment of Wrist and Finger Spasticity after a Stroke.” N Engl J Med. 2002; 347(6): 382-383, 395-400.

2. Hesse S, Brandi-Hesse B, Bardeleben A. “Botulinum toxin A treatment of adult upper and lower limb spasticity.” Drugs Aging. 2001; 18(4): 255-62.

3. Pandyan AD, Vuadens P, van Wijck FM. “Are we underestimating the clinical efficacy of botulinum toxin (type A)? Quantifying changes in spasticity, strength and upper limb function after injections of Botox to the elbow flexors in a unilateral stroke population.” Clin Rehabil. 2002; 16(6):654-60.

4. Slawek J, Bogucki A, Reclawowicz D. “Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualized, flexible injection regimens.” Neurol Sci. 2005; 26(1): 32-9.

5. Rousseaux M, Cornpere S, Launay MJ. “Variability and predictability of functional efficacy of botulinum toxin injection in leg spastic muscles.” J Neurol Sci. 2005; 232(1-2): 51-57.