{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T01:53:40Z","timestamp":1782006820546,"version":"3.54.5"},"reference-count":46,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T00:00:00Z","timestamp":1625184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"from German federal state North Rhine Westphalia (NRW) and the European Union (European Regional Development Fund: Investing in Your Future","award":["(Grant number: EFRE-0800962\/LS-1-2-015d)"],"award-info":[{"award-number":["(Grant number: EFRE-0800962\/LS-1-2-015d)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>The objective of this study was to quantify the increase in efficacy during the first four cycles of treatment with botulinum toxin type\/A (BoNT\/A) in 24 free-walking BoNT\/A na\u00efve adult patients with post-stroke hemispasticity and spastic foot drop. Patients were followed over 390 days and received five injections of 800 U aboBoNT\/A every three months. Patients assessed the treatment effect at eight visits using a global assessment scale, physicians scored the muscle tone at the ankle joint, measured active and passive ranges of motion (aRoMs, pRoMs) at the knee and ankle joint and determined the distance patients succeeded to walk during a minute. Patients\u2019 assessments significantly (p &lt; 0.006) increased with time and significantly correlated with all parameters measured. The best correlation (r = 0.927; p &lt; 0.0001) was found with the sum of the aRoMs of knee and ankle joint. After one year of treatment outcome measures were better than and significantly correlated with the peak effect of the first injection. This correlation was higher for pRoMs (r = 0.855; p &lt; 0.00001) compared to aRoMs (r = 0.567; p &lt; 0.009). When BoNT\/A treatment of the spastic foot in chronic hemispasticity is performed regularly every three months for at least one year, patients will experience a significant increase of benefit beyond the first treatment, but have to learn how to adapt to and use the new degree of freedom induced by the injections.<\/jats:p>","DOI":"10.3390\/toxins13070466","type":"journal-article","created":{"date-parts":[[2021,7,4]],"date-time":"2021-07-04T22:35:22Z","timestamp":1625438122000},"page":"466","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Continuous Increase of Efficacy under Repetitive Injections of Botulinum Toxin Type\/A beyond the First Treatment for Adult Spastic Foot Drop"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1069-7684","authenticated-orcid":false,"given":"Harald","family":"Hefter","sequence":"first","affiliation":[{"name":"Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Nickels","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 D\u00fcsseldorf, Germany"},{"name":"Department of Neurology, Ruland-Kliniken, Neuenb\u00fcrger Strasse 49, D-75335 Dobel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3593-1852","authenticated-orcid":false,"given":"Sara","family":"Samadzadeh","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Albrecht","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2165\/00019053-200422004-00004","article-title":"The burden of coronary, cerebrovascular and peripheral arterial disease","volume":"22","author":"Bakhai","year":"2004","journal-title":"Pharmacoeconomics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2718","DOI":"10.1161\/01.STR.0000035286.87503.31","article-title":"Characterization of incident stroke signs and symptoms: Findings from the atherosclerosis risk in communities\u2019 study","volume":"33","author":"Rathore","year":"2002","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1191\/0269215502cr512oa","article-title":"Prevalence of spasticity post stroke","volume":"16","author":"Watkins","year":"2002","journal-title":"Clin. 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