Pooled systematic studies that compare treatment stragegies for post-stroke spasticity prove that Botulinum toxin-A (BoNT-A) has superior efficacy and safety and has become the first line management in tandem with physiotherapy. The natural evolution of spasticity show that, not only are neural mechanisms of muscle hypertonus come into play, but that biomechanical forces may likely set in 3 months after stroke. Uses of BoNT-A have been driven by pre-defined goals in the established stage of spasticity (i.E. > 6 months from onset of stroke), as well as the practice of repeat cycle injections to reduce muscle tone. About 19-33% of patients develop spasticity within 3 months after the ictus. Early intervention with BoNT-A (i.e. < 3 months from onser stroke spasticity) can be aimed at preventing the increasing severity of spasticity and the contracture development. There are two randomiaed double blind placebo-controlled trials, and a one single blind comparator trial with a non-injected group, that have recently been performed as early BoNT-A intervention, in tandem with rehabilitation. All the 3 trials showed benefit in terms of reduction in muscle tone with BoNT-A, and one study showed improvement in function, in subanalysis of severely weak muscles at baseline. In the large double blind placebo controlled study, pain reduction was achieved and muscle tone had sustained reduction over the longitudinal observation of 24 weeks, despite a single cycle injection of BoNT-A. The combination of early nrurorehabilitation and early BoNT-A application is an appealing therapeutic approach for upper limb post-stroke spasticity. Neurorehabilitation by constraint-induced movement therapy, in tandem with BoNT-A have been proven to reduce muscle overactivity and improve motor control, but remains to be established in a setting of early spasticity.

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OBJECTIVE: To determine the prevalence of anxiety and its correlation with the quality of life among cognitively-intact, community dwelling Filipino patients with idiopathic Parkinson disease (PD) seen at the Movement Disorders Clinic of a tertiary hospital.
STUDY DESIGN: Prospective, cross-sectional study.
METHODS: Seventy six (76) Filipino outpatients fulfilling the United Kingdom Parkinson Disease Society Brain Bank Clinical Diagnostic Criteria for PD were included in the study. Demographic data were obtained including: age, sex, onset of disease, disease duration and medication intake. The Mini Mental State Examination (MMSE) was done to exclude significant cognitive impairment. The Hamilton Anxiety scale (HAM-A) was administered to quantify anxiety. The degree of anxiety was correlated with the quality of life instrument, Short form health survey (SF 36); and the functional and motor severity using the Unified Parkinson Disease Rating Scales (UPDRS).
FINDINGS: Our cohort of patients had a mean: age of 61 years (range: 42 - 81 years), and disease duration of 1.3 years (33 months). Out of the 76 patients, 37( 48.6%) probably had significant anxiety symptoms based on the the HAM A. Anxiety greatly impacts scores on SF 36.
CONCLUSION: The prevalence of anxiety among this Filipino cohort of patients is 48.6% which is higher than commonly reported worldwide. The presence of anxiety significantly correlated with poorer quality of life.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Anxiety ; Anxiety Disorders ; Brain ; Cognition Disorders ; Cognitive Dysfunction ; Parkinson Disease ; Quality Of Life