Upper limb spasticity is a common complication of stroke that negatively affects motor function, range of motion, and quality of life. Although abobotulinumtoxinA is widely used for the treatment of focal post-stroke spasticity, evidence regarding its early onset of action remains limited. This prospective observational pilot study investigated the early clinical, functional, and neurophysiological effects of abobotulinumtoxinA in 20 adults with post-stroke upper limb spasticity. Patients received ultrasound-guided injections into the biceps brachii and flexor digitorum superficialis muscles and were evaluated at baseline, 24 h, 5 days, 7 days, 14 days, and 30 days after treatment. Outcome measures included the Modified Ashworth Scale (MAS), passive range of motion (ROM), caregiver-reported hand function assessed using a visual analog scale (VAS), and compound muscle action potential (cMAP) recordings. No significant changes were observed at 24 h. A significant reduction in spasticity was detected at the day-5 assessment, accompanied by significant improvements in ROM and functional outcomes. Neurophysiological assessment demonstrated significant reductions in cMAP amplitudes at the day-5 assessment, indicating early neuromuscular transmission blockade. Clinical improvements were also first detected at day-5 assessment and were maintained at subsequent evaluations through day 30. These findings indicate that clinically meaningful effects of abobotulinumtoxinA were detectable by the first scheduled assessment at day 5 after injection. Given the absence of intermediate assessments between 24 h and day 5, the exact timing of treatment onset cannot be determined. A multimodal assessment approach may help characterize early treatment-related changes and provide useful information for future studies investigating the timing of adjunctive rehabilitation interventions.

Background: Spasticity is a common feature of Upper Motoneuron Syndrome and is frequently treated with intrathecal baclofen (ITB) when oral therapy is ineffective or poorly tolerated. Different baclofen formulations are available for intrathecal use, but evidence regarding their clinical equivalence in patients requiring high daily doses remains limited. Methods: Thirty adult patients (mean age 37 ± 5.8 years) receiving long-term ITB therapy were switched from four vials of baclofen 10 mg/5 mL to a single vial of baclofen 40 mg/20 mL, while maintaining the same total drug amount and reservoir concentration. Patients were divided into two groups: in 15 patients, the daily baclofen dose was maintained unchanged, while in the remaining 15 patients a 10% dose reduction was attempted. Clinical outcomes were assessed at baseline and during follow-up using validated scales for spasticity, pain, and functional status. Results: In patients with unchanged daily dosing, no clinically relevant differences were observed in spasticity, pain, or functional independence after switching formulation, supporting clinical equivalence between the two preparations. Conversely, the 10% dose reduction proved clinically unsustainable in patients requiring high daily doses and required restoration of baseline dosing in all cases. No adverse events or formulation-related complications were observed. Conclusions: Switching to baclofen 40 mg/20 mL is safe and clinically equivalent to the conventional 10 mg/5 mL formulation when the daily dose is maintained unchanged. Dose reduction appears unsuitable in patients requiring high daily intrathecal baclofen doses.

Background: Complex regional pain syndrome type I (CRPS-I) is a condition characterised by pain, swelling, loss of function, trophic skin changes and vasomotor dysfunction. Biophysical stimulation with a specific combination of pulsed electromagnetic field (PEMF) parameters exerts an anti-inflammatory effect, supporting the rehabilitation process. Materials and methods: We recruited 32 patients with CRPS-I of the foot or ankle, previously treated with an initial course of IV neridronate. Participants were randomised to one of two groups: a treatment programme combining PEMF (1.5 mT, 75 Hz; I-One ^® therapy, IGEA) for 4 h a day for 60 days and exercises for 30 min a day for 6 weeks (I-One ^® therapy group), or treatment with exercise only (control group). Patients were clinically assessed at 3, 6 and 12 months with: Visual Analogue Score (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, allodynia, hyperalgesia, pain during passive range of motion (ROM), oedema, Roles and Maudsley scores and non-steroidal anti-inflammatory drug (NSAID) intake. Results: In both groups, VAS was significantly reduced and AOFAS improved significantly compared with baseline at all follow-up points. The I-One ^® therapy group saw statistically significant improvements compared with the control group at all follow-up points, not only in terms of VAS and AOFAS scores, but also in the resolution of allodynia, hyperalgesia and pain during passive ROM. At 3 months, the I-One ^® therapy group also showed a significantly lower intake of NSAIDs. The I-One ^® therapy group showed better patient satisfaction outcomes, with significantly lower Roles and Maudsley scores compared with the control group at 6 and 12 months. Conclusions: I-One ^® therapy in association with a rehabilitation program may offer additional benefits in terms of pain reduction, functional recovery, oedema, allodynia and hyperalgesia resolution and NSAIDs use in CRPS-I of the foot and ankle. Trial registration: registered on the ClinicalTrials.gov platform (NCT05922618) on 6 August 2023. Level of evidence: Level II, therapeutic study.