Sequential use of botulinum toxin A and bovhyaluronidase azoximer in the correction of post-stroke spasticity

A clinical case of consistent use of botulinum toxin type A (BTA) and azoximer bovhialuronidase (BA) in a 69-year-old patient who suffered an ischemic stroke (II) with right-sided hemiparesis is presented. BTA (incobotulotoxin) was injected under ultrasound control (ultrasound) into the muscles of the target pathological patterns at a dose of 500 units. After 3 weeks, under the control of ultrasound navigation, BA was injected into the 2 most fibrotic shoulder muscles at a dose of 3.000 IU (1.500 IU each). The effectiveness of therapy was monitored using a modified Ashworth scale (MAS), goniometry, and electromyography. A decrease in the severity of the leading pattern of spasticity of the muscles of the upper extremity (on the MAS scale) after injection of BTA was found. After consistent application of BA, a distinct change in the structure of muscle tissue and a decrease in tone in spastic muscles were recorded. The results obtained confirm the safety of botulinum therapy and the good tolerability and efficacy of Xeomin in a patient with spasticity with contracture formation after AI. The introduction of ASTHMA after botulinum therapy makes it possible to increase the elasticity of spastic muscles by reducing the severity of fibrous changes and improving motor function.