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Combined rehabilitation therapy with botulinum toxin to the upper limbs for acute spinal cord injury: A case report

Spinal Cord Series and Cases volume 10, Article number: 33 (2024) Cite this article

Subjects

Abstract

Introduction

Patients with spinal cord injury (SCI) and incomplete paralysis may experience muscle immobilization due to functional impairment of agonist and antagonist muscles. This can induce spasticity and pain, with the risk of contracture increasing as the period of immobilization increases. This could be aggravated by pain, which interferes with rehabilitation. There is no established treatment for pain and joint contractures caused by acute SCI. Botulinum therapy plays a role in relieving muscle tension. Here, we report a case of acute SCI in which botulinum therapy was administered.

Case presentation

The patient experienced a C5-cervical SCI due to a road traffic accident, with marked paralysis in the upper and lower limbs below the C5 level. The patient had persistent elbow flexion since the SCI and complained of excruciating pain, making adequate rehabilitation difficult. Botulinum toxin was administered to the biceps and brachialis muscles 15 days after the SCI. After administration, the patient experienced a reduction in pain with relaxation of the elbow flexor muscles, and rehabilitation treatment was resumed. This patient’s contracture did not worsen, his pain decreased, and he was able to initiate self-feeding training.

Discussion

In this case, occupational and physical therapy was administered with botulinum therapy. Together, they successfully reduced pain. Botulinum therapy provides analgesia and muscle relaxation and may lead to functional recovery, and we believe that treatment can be considered even in the acute phase.

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Fig. 1: Clinical course of symptoms and rehabilitation treatment.

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Data availability

The original data have been stored by the corresponding author and can be sent upon reasonable request.

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Acknowledgements

We thank the staff of the Department of Rehabilitation Medicine at the Nara Prefecture General Medical Center.

Funding

This study received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Rehabilitation, Nara Prefecture General Medical Center, Nara city, Japan

    Haruki Mori, Gosuke Satoh, Hideki Takashima, Takashi Masuda & Tomoo Mano

  2. Department of Neurology, Nara Medical University, Nara city, Japan

    Tomoo Mano

Authors
  1. Haruki Mori
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  2. Gosuke Satoh
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  3. Hideki Takashima
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  4. Takashi Masuda
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  5. Tomoo Mano
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Contributions

HM and TMano contributed to the study conception and design. HM, TMano, and GS collected the clinical data. HM and TMano wrote the manuscript. GS and TM revised the manuscript. HT and TMasuda supervised the study. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Tomoo Mano.

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Competing interests

We confirm that there are no known conflicts of interest associated with this publication and that there has been no significant financial support for this work that could have influenced its outcome. The authors have no potential conflicts of interest or financial interests to disclose.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki and approved by the appropriate ethics committee of the Nara Prefecture General Medical Center. Informed consent was obtained from the patient for the publication of the report and associated images.

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Mori, H., Satoh, G., Takashima, H. et al. Combined rehabilitation therapy with botulinum toxin to the upper limbs for acute spinal cord injury: A case report. Spinal Cord Ser Cases 10, 33 (2024). https://doi.org/10.1038/s41394-024-00647-0

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