Objective: To investigate the efficacy of local intramuscular injection of botulinum toxin A (BTX-A) guided by electromyography (EMG) in the treatment of limb spasm after stroke.

Methods: The subjects were 96 patients with spastic hemiplegia after stroke. According to the results of the Fugl-Meyer Assessment (FMA) scale of upper limbs or lower limbs with severer spasticity, these 96 patients were divided into upper limbs group A (n = 26, score ≥51), group B (n = 21, score 34-50) and group C (n = 9, score ≤33), and lower limbs group A (n = 25, score ≥23), group B (n = 12, score 17-22) and group C (n = 3, score ≤16). Local intramuscular injection of BTX-A (a multi-point injection, the total dose of each patient ≤400 U) was performed under the guidance of EMG, and combined with limb function training. One month, three months and six months after treatment, the efficacy was evaluated by Modified Ashworth Scale, FMA scale, Modified Barthel Index, World Health Organization Quality of Life Assessment Instrument, Self-rating Depression Scale, Self-rating Anxiety Scale and EMG.

Results: One month, three months and six months after treatment, the FAM scale scores of upper limbs groups A and B were 60.35±1.51, 62.35±3.01 and 64.10±2.56, and 39.10±2.23, 42.12±2.34 and 43.09±1.89, respectively; the FAM scale scores of lower limbs groups A and B were 33.16±1.06, 33.45±2.14 and 33.89±2.08, and 20.95±3.75, 23.45±2.20 and 24.12±1.89, respectively. The scores of FAM scale in group A and group B were significantly improved after treatment (P < 0.05), but there was no significant difference in the score of FAM scale in group C after treatment as compared with that before treatment (P > 0.05). One month after treatment, there were significant differences in total marked efficiency and total effective rate among group A, group B and group C (P < 0.05), but there were no significant differences in total marked efficiency and total effective rate among group A, group B and group C after 3 months and 6 months of treatment (P > 0.05). The Modified Barthel Index scores of 96 patients at 1, 3 and 6 months after treatment were not significantly improved compared with those before treatment (P > 0.05); besides environmental score, the physiological, psychological and social relationship scores of the World Health Organization Quality of Life Assessment Instrument were significantly increased compared with those before treatment (P < 0.05); the scores of Self-rating Depression Scale and Self-rating Anxiety Scale were significantly decreased compared with those before treatment (P < 0.05). The activities of spontaneous potential at rest in group A and group B were significantly lower than those before treatment, but there was no significant change in group C compared with that before treatment. 

Conclusion: Local intramuscular injection of BTX-A has a remarkable effect on limb spasm after stroke. Combined with effective rehabilitation training, muscle spasm can be quickly alleviated or eliminated, and the quality of life and the mood can be improved.