ARTICLE IN PRESS

Abstracts Toxins 2008 / Toxicon 51 (2008) 1–54 25

Prior electromyography (EMG) and electrical stimulation(E-stim)-guided injections of Botulinum Toxin A (BoNT/A)had produced suboptimal results. To optimize function,we repeated the injections, using ultrasound as theguidance method, which resulted in improved handfunction. To our knowledge, this is the first report toillustrate the advantages of using ultrasound as aguidance method for intramuscular injections of BoNT/Ain patients with writer’s cramp.

Keywords: Focal dystonia; Ultrasound; Botulinum toxin A

10.1016/j.toxicon.2008.04.075

74. Clinically meaningful differences of the AshworthScale in patients with chronic post-stroke upper limbspasticity treated with botulinum neurotoxin type A(botoxs)

David Charles a, R. Zafonte b, M.V. Shah c,A.M. VanDenburgh c, J. Wagg d, T. Khariton d, S. Hua c,F.C. Beddingfield c,e, S. Abu-Shakra c, M.F. Brin c,f

a Department of Neurology, Vanderbilt University Medical Center,

Nashville, USAb Harvard Department of Physical Medicine and Rehabilitation, Spaulding

Rehabilitation Hospital, Boston, MA, USAc Global Clinical Development, Allergan, Inc, Irvine, CA, USAd Pharsight Corporation, Mountain View, CA, USAe Department of Medicine, David Geffen School of Medicine at UCLA, Los

Angeles, CA, USAf Allergan, Inc and Department of Neurology, University of California, Irvine,

CA, USA

We describe the clinical importance of changes inAshworth Scale (AS) scores in chronic post-strokespasticity patients. Data from 3 clinical trials including442 patients were pooled and analyzed. Changesfrom baseline in the AS were compared to the PhysicianGlobal Assessment score (PGAS). Receiver OperatorCurve (ROC) analyses with wrist flexor AS change frombaseline as the independent variable and PGAS as thedependent variable were performed to estimate clinicallymeaningful changes in spasticity using the criteria forclinical meaningfulness of PGAS X1 (mild improvementor better) and PGAS X2 (moderate improvement orbetter). Pearson correlation for the change in wrist ASand PGAS was �0.44 (p ¼ 0, t ¼ 26.5), with correlations of�0.45 and �0.22 noted for the finger and elbow (po0.01in each comparison). By ROC analysis, a PGAS of X1was associated with 33% reduction of wrist AS and aPGAS of X2 was associated with approximately 50%reduction. These analyses demonstrate that decreases inAshworth scores are recognized by physicians as beingbeneficial to patients. A reduction of 33% in the wrist ASrepresents a clinically important difference. This issimilar to findings from pooled chronic pain studies inwhich a 30% change was considered clinically important(Farrar et al., 2001).

Study supported by: Allergan, Irvine, CA

Keywords: Rehabilitation; Botulinum neurotoxin type A; Spasticity;

Stroke

10.1016/j.toxicon.2008.04.076

75. Botulinum toxins for the treatment ofcervical dystonia

Cynthia ComellaRush University, Chicago, USA

Cervical dystonia is one of the most frequent focaldystonias evaluated in a clinical setting. Although numer-ous oral medications and surgical interventions areavailable, most have not been adequately tested or requireinvasive procedures. Botulinum neurotoxin (BoNT) treat-ment is a safe and effective treatment for cervical dystoniathat has been evaluated in numerous randomized,placebo-controlled studies. There are two serotypes ofBoNT (A and B) that are available in most countries of theworld. In addition, there are several different brands ofBoNT-A that are used for CD treatment, some of which areonly available in selected geographic regions. In mostcontrolled studies, BoNT provides significant improve-ment following treatment for head posture, pain anddisability. The common side effects of treatment includedysphagia, dry mouth, and neck weakness. Each brandand serotype is pharmacologically distinct. The dosing ofeach type differs, and no simple dose equivalency hasbeen established. With repeated treatment, the develop-ment of immunoresistance is observed in a percentage ofpatients. However, it is likely that each brand and serotypediffers in immunogenic potential and occurrence ofsecondary unresponsiveness, an issue that is currentlyunder active investigation.

Keywords: Botulinum toxin; Cervical dystonia; Spasmodic torticollis

10.1016/j.toxicon.2008.04.077

76. A case of PKAN treated with botulinum toxin A

Claudio Crisci a, Marcello Esposito b

a Clinic Center, Private Hospital for Rehabilitation, Napoli, Italyb Department of Neurological Sciences ‘‘Federico II’’ University, Napoli, Italy

A 26-year-old girl had typical clinical presentation ofpantothenate kinase associated neurodegeneration(PKAN) and autosomal recessive transmission was eval-uated. She had marked contractions of the lower facialmuscles and severe contraction of calf muscles, with bothfeet in a crooked position, more evident on the left side.Since infancy, she walked abnormally and was unstablewhen standing, due to rapidly progressive hypertonia oflower limbs. She could walk only with double support andusing a rigid ankle–foot orthesis in both legs to correct forinternal foot rotation. Walking barefoot was impossible.Hyperactivity of the medial calf muscles (tibialis posteriorand medial gastrocnemius) was evident upon inspectionand EMG recording.

In order to reduce the abnormal foot posture andprevent falls, we injected both legs with botulinum toxinA: 200 Dysports U in the motor points of the tibialisposterior muscle and 200 Dysports U in the medial partof gastrocnemius muscle. She continued to follow athorough daily rehabilitation to improve balance and