Use of botulinum toxin A in improving health outcomes in post-stroke spasticity and patients with foot dystonia

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dc.contributor.advisorVisvanathan, Renuka
dc.contributor.advisorCameron, Ian
dc.contributor.authorDatta Gupta, Anupam
dc.contributor.schoolAdelaide Medical School
dc.date.issued2025
dc.description.abstractStroke and Parkinson’s disease (PD) are major public health concerns, often resulting in spasticity and dystonia that impair function and limit the quality of life. Botulinum neurotoxin A (BoNTA) shows promise in managing these symptoms. When embarking on this research, literature evidence was limited regarding the effectiveness of BoNTA in improving spasticity in the lower limb and hands (to promote healing of hand ulcers) post-stroke, and foot dystonia following deep brain stimulation (DBS) in PD patients. The thesis goal was to conduct research to better understand BoNTA’s efficacy in reducing moderate to severe spasticity and dystonia to improve patient outcomes. The three key research questions addressed were i) can BoNTA improve mobility and quality of life in post-stroke lower limb spasticity; ii) does BoNTA relieve foot dystonia and enhance gait in PD patients, and iii) does the opening of hands by treating post-stroke hand spasticity with BoNTA lead to the healing of underlying ulcers, reduce pain and reduce carer burden? To answer the first research question, a systematic review of the efficacy of botulinum toxin in walking and quality of life in post-stroke lower limb spasticity was undertaken to understand the opportunities for research and this led to the design of a randomised control trial (RCT) for which funding was secured. Unfortunately, because of the pandemic, the RCT was reduced to a pilot study and the aim was to trial the intervention and gain an understanding of suitable outcome measures. No effect on outcomes were noted and the effect sizes for all outcomes except one (a secondary outcome) were small, recruitment was slow from a single centre pointing to the need for future research to be multi-centred. The second and third research questions were explored using observational studies in the form of case studies or case series. Two case series documented significant relief of foot dystonia and gait improvements in Parkinson’s patients with DBS after BoNTA treatment. Additionally, a case study and a case series evaluated BoNTA's effectiveness in treating chronic, painful, treatment-resistant hand ulcers from post-stroke spasticity. By addressing gaps in clinical care for vulnerable patient groups, this research offers valuable insights despite their observational design, laying the groundwork for the design of more robust studies. To conclude, this research has direct relevance to the clinical work of rehabilitation physicians and the insights further confirmed that BoNTA is safe treatment that can have benefits in improving post-stroke spasticity and dystonia in PD patients. In turn, improvements in those two neurological complications contribute to improved patient health outcomes. The research provides insights to inform the design and conduct of more definitive research, which should include valid, reliable and responsive outcome measures.
dc.description.dissertationThesis (Ph.D.) -- University of Adelaide, Adelaide Medical School , 2025en
dc.identifier.urihttps://hdl.handle.net/2440/146222
dc.language.isoen
dc.provenanceThis electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legalsen
dc.subjectSpasticity
dc.subjectbotulinum toxin
dc.subjectstroke
dc.subjectdystonia
dc.subjectParkinson's disease
dc.titleUse of botulinum toxin A in improving health outcomes in post-stroke spasticity and patients with foot dystonia
dc.typeThesisen

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