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1323 - Getting a Leg Up on Refractory Vastus Lateralis Spasticity: A Case Report

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

LR

Lance Reccoppa, MD

Resident Physician
Jackson Health System/University of Miami
MIami, Florida, United States

Co-Author(s)

JV

Jose R. Vives, MD

Assistant Professor / Attending Physician
University of Miami Miller School of Medicine / PM&R Department
Miami, Florida, United States

Case Diagnosis: Botulinum Toxin Injection for refractory Vastus Lateralis Spasticity

Case Description: A 53-year-old male with a history of spina bifida visited the clinic for evaluation and management of spasticity. He complained of severe cramps and spasms in his left lower extremity, particularly at the lateral aspect of his thigh. These symptoms had persisted for several years and had not responded to oral antispastic medications. Upon examination, the patient exhibited persistent involuntary muscle contractions in his left vastus lateralis with a Modified Ashworth Scale of 1 during knee flexion and extension. It was decided to inject 100 units of botulinum Toxin A into his left quadriceps under EMG guidance. When the patient returned to the clinic 4 weeks later, he reported a 95% relief after the injection, was highly satisfied with the results, and showed improved spasticity during the physical exam. He plans to return in 4 months to receive 200 units of botulinum toxin in his rectus femoris and vastus lateralis.

Discussions: Botulinum toxin is currently approved by the US Food and Drug Administration (FDA) for the treatment of lower limb spasticity in specific muscles, including the gastrocnemius, soleus, tibialis posterior, flexor hallucis longus, and flexor digitorum longus. Although other lower extremity muscles are not FDA-approved, they are still injected with botulinum toxin for focal dystonia. In a systematic review of over 2100 patients who received botulinum injections, only 0.7% received vastus lateralis injections, with dosing ranging from 25 units to 60 units.

Conclusions:

This case emphasizes the need to further study patients with vastus lateralis spasticity and examines the potential for botulinum toxin injection as a treatment modality for these patients in the future.