• Sun Im, Joo Hyun Park, Seong Kon Son, Jae-Eun Shin, Sae Hoon Cho, and Geun-Young Park.
• Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea.
• Clin Rehabil. 2014 Jun 1; 28 (6): 604-13.

ObjectiveTo determine if botulinum toxin type A injection at the proximal 2/10 and 3/10 of calf length, where the intramuscular nerve endings of the gastrocnemius muscle are densely distributed, is more efficacious in controlling plantarflexion spasticity than injection at distant sites within the same muscle.DesignA double-blind randomized controlled trial.SetttingTwo rehabilitation centres.SubjectsForty stroke patients were randomly allocated to two groups. Group A received injection at the proximal 2/10 and 3/10 of calf length, group B at and below the midbelly of the muscle. Both groups received 200 IU of botulinum toxin A and were followed up to eight weeks.Main MeasuresPrimary variables were the surface electromyography values recorded during plantarflexion; secondary variables were the Modified Ashworth Scale, Modified Tardieu Scale, clonus scale, 10-metre walking test, ABILOCO and Functional Ambulation Categories.ResultsAt baseline, the median Modified Ashworth Scale was 2.0 (range,1+ -3.0), and there were no significant differences between the two groups in all the parameters, including spasticity. Compared to baseline, no significant differences between the two groups were detected in all the surface electromyography and clinical parameters at week 8 (P > 0.05). Both groups showed significant improvement of spasticity with a median Modified Ashworth Scale of 1+ (range, 0.0-2.0) at eight weeks.ConclusionsBotulinum toxin A injection was associated with a significant improvement from baseline to week 8 in both treatment groups, however, no significant difference between the 2 groups was observed, based on the electrophysiological and clinical parameters employed in this study.© The Author(s) 2014.

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