SBOTE study: extracorporeal shock wave therapy versus electrical stimulation after botulinum toxin type a injection for post-stroke spasticity-a prospective randomized trial

Ultrasound Med Biol. 2013 Feb;39(2):283-91. doi: 10.1016/j.ultrasmedbio.2012.09.019. Epub 2012 Dec 14.


Research is on-going to identify new methods of biostimulation to increase the effect of botulinum toxin type A (BTX-A) in the treatment of spasticity. The Spasticity treated by Botulinum Toxin and ESWT (SBOTE) study is a prospective, randomized controlled trial assessing the effectiveness of extracorporeal shock wave therapy (ESWT) given immediately after BTX-A injections compared with electrical stimulation (ES) given immediately after BTX-A therapy for the management of focal upper limb spasticity in stroke patients. ES was given for 30 min twice a day for 5 days starting at 5 Hz; ESWT was given once a day for 5 days. At study follow-up, patients treated with BTX-A injections and ESWT showed a statistically greater significance and continuous decrease of spasticity measure (modified Ashworth scale [MAS]: 1.37, 1.75 and 1.58 at 15, 30 and 90 days post-treatment, respectively), of spasms (spasm frequency scale [SFS]: 0.8 and 0.25 at 30 and 90 days post-treatment, respectively) and of pain (visual analogue scale [VAS]: 1.94 and 1.87 at 30 and 90 days, respectively) compared with patients treated with BTX-A injections and ES (MAS: 2.37, 2.18 and 2.18, respectively) (p < 0.05) (SFS: 1.5 and 1.06, respectively) (p < 0.05) (VAS: 2.44 and 2.69 respectively) (p < 0.05). ESWT enhances the effect of BTX-A to a greater extent than ES, probably by modulating rheology of the muscle and neurotransmission at the neuromuscular junction.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Botulinum Toxins, Type A / administration & dosage*
  • Combined Modality Therapy
  • Electric Stimulation Therapy / methods*
  • Female
  • High-Intensity Focused Ultrasound Ablation / methods*
  • Humans
  • Male
  • Muscle Spasticity / diagnostic imaging
  • Muscle Spasticity / etiology*
  • Muscle Spasticity / therapy*
  • Neuromuscular Agents / administration & dosage
  • Stroke / complications*
  • Stroke / diagnostic imaging
  • Stroke / therapy*
  • Treatment Outcome
  • Ultrasonography


  • Neuromuscular Agents
  • Botulinum Toxins, Type A