We updated the design of this site on September 25th. Learn more.
Show more
ClinicalTrials.gov
ClinicalTrials.gov Menu

Efficacy and Safety Study of Botulinum Toxin Type A Against Placebo to Treat Spasticity in the Arm After a Stroke (PURE)

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01392300
First Posted: July 12, 2011
Last Update Posted: January 16, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Information provided by (Responsible Party):
Merz Pharmaceuticals GmbH
  Purpose
The purpose of this study is to determine whether injections of Botulinum toxin type A into muscles of the upper limb are effective in treating spasticity in patients after stroke.

Condition Intervention Phase
Post-stroke Spasticity of the Upper Limb Drug: IncobotulinumtoxinA (400 Units) Drug: Placebo Comparator Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Prospective, Double-blind, Placebo-controlled, Randomized, Multi-center Study With an Open-label Extension Period to Investigate the Efficacy and Safety of NT 201 in the Treatment of Post-stroke Spasticity of the Upper Limb

Further study details as provided by Merz Pharmaceuticals GmbH:

Primary Outcome Measures:
  • Change From Baseline in Ashworth Scale (AS) Score of Primary Target Clinical Pattern [ Time Frame: Week 4 ]

    Primary target clinical pattern was defined by investigator for each subject at baseline visit and was either flexed wrist or clenched fist or flexed elbow.

    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).


  • Investigator's Global Impression of Change [ Time Frame: Week 4 ]
    This is the co-primary outcome measure. The Global Impression of Change Scale [GICS] is used to measure the investigator's impression of change due to treatment. The response option is a common 7-point Likert scale that ranges from -3 = very much worse to +3 = very much improved.


Secondary Outcome Measures:
  • Response Rates on the Ashworth Scale at Week 4 Calculated for the Primary Target Clinical Pattern [ Time Frame: Week 4 ]
    Primary target clinical pattern was defined by investigator for each subject at baseline visit and was either flexed wrist or clenched fist or flexed elbow. Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 8 Calculated for the Primary Target Clinical Pattern [ Time Frame: Week 8 ]
    Primary target clinical pattern was defined by investigator for each subject at baseline visit and was either flexed wrist or clenched fist or flexed elbow. Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 12 Calculated for the Primary Target Clinical Pattern [ Time Frame: Week 12 ]
    Primary target clinical pattern was defined by investigator for each subject at baseline visit and was either flexed wrist or clenched fist or flexed elbow. Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 4 Calculated for the Muscle Group Flexed Wrist [ Time Frame: Week 4 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 8 Calculated for the Muscle Group Flexed Wrist [ Time Frame: Week 8 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 12 Calculated for the Muscle Group Flexed Wrist [ Time Frame: Week 12 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 4 Calculated for the Muscle Group Flexed Elbow [ Time Frame: Week 4 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 8 Calculated for the Muscle Group Flexed Elbow [ Time Frame: Week 8 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 12 Calculated for the Muscle Group Flexed Elbow [ Time Frame: Week 12 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 4 Calculated for the Muscle Group Clenched Fist [ Time Frame: Week 4 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 8 Calculated for the Muscle Group Clenched Fist [ Time Frame: Week 8 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 12 Calculated for the Muscle Group Clenched Fist [ Time Frame: Week 12 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 4 Calculated for the Muscle Group Thumb-in-palm [ Time Frame: Week 4 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 8 Calculated for the Muscle Group Thumb-in-palm [ Time Frame: Week 8 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 12 Calculated for the Muscle Group Thumb-in-palm [ Time Frame: Week 12 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 4 Calculated for the Muscle Group Pronated Forearm [ Time Frame: Week 4 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 8 Calculated for the Muscle Group Pronated Forearm [ Time Frame: Week 8 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Response Rates on the Ashworth Scale at Week 12 Calculated for the Muscle Group Pronated Forearm [ Time Frame: Week 12 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension). Subjects with a reduction of one point were defined as responder for the aim of the efficacy analysis.

  • Changes From Baseline to Week 4 in Ashworth Scale Score for Treated Muscle Group Flexed Wrist. [ Time Frame: Week 4 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 8 in Ashworth Scale Score for Treated Muscle Group Flexed Wrist. [ Time Frame: Week 8 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 12 in Ashworth Scale Score for Treated Muscle Group Flexed Wrist. [ Time Frame: Week 12 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 4 in Ashworth Scale Score for Treated Muscle Group Flexed Elbow. [ Time Frame: Week 4 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 8 in Ashworth Scale Score for Treated Muscle Group Flexed Elbow. [ Time Frame: Week 8 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 12 in Ashworth Scale Score for Treated Muscle Group Flexed Elbow. [ Time Frame: Week 12 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 4 in Ashworth Scale Score for Treated Muscle Group Clenched Fist. [ Time Frame: Week 4 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 8 in Ashworth Scale Score for Treated Muscle Group Clenched Fist. [ Time Frame: Week 8 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 12 in Ashworth Scale Score for Treated Muscle Group Clenched Fist. [ Time Frame: Week 12 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 4 in Ashworth Scale Score for Treated Muscle Group Thumb-in-palm. [ Time Frame: Week 4 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 8 in Ashworth Scale Score for Treated Muscle Group Thumb-in-palm. [ Time Frame: Week 8 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 12 in Ashworth Scale Score for Treated Muscle Group Thumb-in-palm. [ Time Frame: Week 12 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 4 in Ashworth Scale Score for Treated Muscle Group Pronated Forearm. [ Time Frame: Week 4 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 8 in Ashworth Scale Score for Treated Muscle Group Pronated Forearm. [ Time Frame: Week 8 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 12 in Ashworth Scale Score for Treated Muscle Group Pronated Forearm. [ Time Frame: Week 12 ]
    The Ashworth Scale is well known and commonly used in clinical trials with spasticity. It was used to categorize severity of spasticity by judging resistance to passive movement. It is a 5-point scale that ranges from 0 (=no increase in tone) to 4 (=limb rigid in flexion or extension).

  • Changes From Baseline to Week 4 in Disability Assessment Scale - Principal Therapeutic Target Domain [ Time Frame: Week 4 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 8 in Disability Assessment Scale - Principal Therapeutic Target Domain [ Time Frame: Week 8 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 12 in Disability Assessment Scale - Principal Therapeutic Target Domain [ Time Frame: Week 12 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 4 in Disability Assessment Scale - Domain Hygiene [ Time Frame: Week 4 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 8 in Disability Assessment Scale - Domain Hygiene [ Time Frame: Week 8 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 12 in Disability Assessment Scale - Domain Hygiene [ Time Frame: Week 12 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 4 in Disability Assessment Scale - Domain Dressing [ Time Frame: Week 4 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 8 in Disability Assessment Scale - Domain Dressing [ Time Frame: Week 8 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 12 in Disability Assessment Scale - Domain Dressing [ Time Frame: Week 12 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 4 in Disability Assessment Scale - Domain Limb Position [ Time Frame: Week 4 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 8 in Disability Assessment Scale - Domain Limb Position [ Time Frame: Week 8 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 12 in Disability Assessment Scale - Domain Limb Position [ Time Frame: Week 12 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 4 in Disability Assessment Scale - Domain Pain [ Time Frame: Week 4 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 8 in Disability Assessment Scale - Domain Pain [ Time Frame: Week 8 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).

  • Changes From Baseline to Week 12 in Disability Assessment Scale - Domain Pain [ Time Frame: Week 12 ]
    The Disability Assessment Scale consists of the four domains hygiene, dressing, limb position, and pain which were assessed on a 4-point scale with the values 0 (=no disability), 1 (=mild disability), 2 (=moderate disability), and 3 (=severe disability).


Enrollment: 317
Study Start Date: September 2011
Study Completion Date: February 2014
Primary Completion Date: March 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: DB IncobotulinumtoxinA (Xeomin) (400 U)
IncobotulinumtoxinA (Xeomin) (400 Units): Main period, one injection session - double-blind (DB), randomized treatment assignment
Drug: IncobotulinumtoxinA (400 Units)
Main period: One injection session of solution, prepared by reconstitution of powder with 0.9% Sodium Chloride (NaCl), 400 units, total volume 8.0 mL; Mode of administration: intramuscular injection
Other Name: Xeomin
Placebo Comparator: DB Placebo Comparator
Placebo to incobotulinumtoxinA (Xeomin) (400 Units): Main period, one injection session - double-blind (DB), randomized treatment assignment
Drug: Placebo Comparator
Main period: one injection session of solution, prepared by reconstitution of powder with 0.9% NaCl, corresponding total placebo volume 8.0 mL; Mode of administration: intramuscular injection

Detailed Description:
The study consists of a randomized, double-blind, placebo-controlled, parallel-group, single-dose main period followed by an open-label, non-controlled, repeated-dose extension period (Open-Label Extension Period - OLEX).
  Eligibility

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Ages Eligible for Study:   18 Years to 80 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Upper limb spasticity
  • Time since stroke greater than 3 months
  • Need for 400 U Botulinum toxin type A

Exclusion Criteria:

  • Body weight below 50kg
  • Fixed contractures of the upper limb
  • Generalized disorders of muscle activity like Myasthenia gravis that preclude use of Botulinum toxin Type A
  • Infection at the injection site
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01392300


  Show 47 Study Locations
Sponsors and Collaborators
Merz Pharmaceuticals GmbH
Investigators
Study Director: Medical Expert Merz Pharmaceuticals GmbH
  More Information

Publications:
Responsible Party: Merz Pharmaceuticals GmbH
ClinicalTrials.gov Identifier: NCT01392300     History of Changes
Other Study ID Numbers: MRZ 60201/SP/3001
2010-023043-15 ( EudraCT Number )
First Submitted: July 7, 2011
First Posted: July 12, 2011
Results First Submitted: January 13, 2016
Results First Posted: February 11, 2016
Last Update Posted: January 16, 2017
Last Verified: November 2016

Additional relevant MeSH terms:
Stroke
Muscle Spasticity
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Muscular Diseases
Musculoskeletal Diseases
Muscle Hypertonia
Neuromuscular Manifestations
Neurologic Manifestations
Signs and Symptoms
incobotulinumtoxinA
Botulinum Toxins, Type A
Neuromuscular Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Acetylcholine Release Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Cholinergic Agents
Neurotransmitter Agents