{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T22:41:08Z","timestamp":1790030468800,"version":"4.0.1"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2014,2,12]],"date-time":"2014-02-12T00:00:00Z","timestamp":1392163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"PharmAllergan GmbH, Ettlingen, Germany"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Spastic pes equinovarus is a frequent pathological posture of the lower extremity. Botulinum toxin (<jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>o<jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>) has been successfully applied to treat lower limb spasticity. However, the best time to initiate treatment remains unclear. A beneficial effect of an early treatment has been suggested in previous studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A single\u2010centre double\u2010blind randomized placebo\u2010controlled trial was performed to investigate the efficacy of <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>o<jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> to reduce muscle hypertonicity at the ankle. Fifty\u2010two patients with unilateral or bilateral spastic pes equinovarus with a modified Ashworth score (m<jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content>) of at least 1+ after stroke, traumatic brain injury or hypoxic encephalopathy were allocated to receive either <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>o<jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> or placebo treatment. A second, open injection was optional at week 12. Patients received unilateral or bilateral injections with 230 or 460\u00a0U onabotulinumtoxinA, respectively. The course of the m<jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content> was explored during the open study phase.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients who had received <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>o<jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> treatment had lower m<jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content> compared with placebo at week 12 (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). During the open label phase, patients from the placebo group showed further deterioration of muscle tone despite starting from a similar baseline and receiving <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>o<jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content> treatment. Spastic feet that had received <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>o<jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> in the first cycle had comparatively lower m<jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content> scores over all follow\u2010up data and at week 24 (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The study demonstrates a reduction of muscular hypertonicity in spastic pes equines with <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>o<jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> treatment given during the first 3\u00a0months after the lesion. Exploratory analyses of the course of muscular hypertonicity during the open phase favour earlier to later treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.12381","type":"journal-article","created":{"date-parts":[[2014,2,12]],"date-time":"2014-02-12T11:48:34Z","timestamp":1392205714000},"page":"1089-1095","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Early botulinum toxin treatment for spastic pes equinovarus \u2013 a randomized double\u2010blind placebo\u2010controlled study"],"prefix":"10.1111","volume":"21","author":[{"given":"U. M.","family":"Fietzek","sequence":"first","affiliation":[{"name":"Department of Neurology and Clinical Neurophysiology Sch\u00f6n Klinik M\u00fcnchen Schwabing Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Kossmehl","sequence":"additional","affiliation":[{"name":"Kliniken Beelitz Neurological Rehabilitation Medical Centre Beelitz\u2010Heilst\u00e4tten Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Schelosky","sequence":"additional","affiliation":[{"name":"Department of Neurology Kantonsspital M\u00fcnsterlingen M\u00fcnsterlingen Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Ebersbach","sequence":"additional","affiliation":[{"name":"Kliniken Beelitz Parkinson's Disease and Movement Disorders Beelitz\u2010Heilst\u00e4tten Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Wissel","sequence":"additional","affiliation":[{"name":"Department of Neurological Rehabilitation and Physical Medicine Vivantes Klinikum Spandau Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,2,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.581991"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2011.03448.x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200629010-00003"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03128.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00812153"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.58.2.232"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(96)90015-5"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.27.3.455"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(98)90068-5"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-199811000-00012"},{"key":"e_1_2_7_12_1","first-page":"87","article-title":"Combined effects of botulinum toxin and casting treatments on lower limb spasticity after stroke","volume":"23","author":"Farina S","year":"2008","journal-title":"Funct Neurol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1191\/0269215505cr827oa"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2008.02112.x"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.61.3.265"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000069495"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.69.4.499"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(00)00146-9"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215511421355"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-010-5463-1"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182762448"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(1997)6 <21::AID-MUS4>3.0.CO;2-L"},{"key":"e_1_2_7_23_1","first-page":"886","article-title":"Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study","volume":"85","author":"Haart M","year":"2004","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-007-0869-3"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/0269905031000149498"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03084.x"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.48.7.676"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/119.5.1737"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1994.tb11863.x"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fene.12381","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fene.12381","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.12381","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T16:20:56Z","timestamp":1695572456000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.12381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2,12]]},"references-count":28,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2014,8]]}},"alternative-id":["10.1111\/ene.12381"],"URL":"https:\/\/doi.org\/10.1111\/ene.12381","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2,12]]},"assertion":[{"value":"2013-08-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-12-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-02-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}