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StrokeNCT06767631

Pilot Study on Muscle, Tendon, and Neural Changes Post-Botulinum Toxin Injections in Post-stroke Spastic Equinovarus

A study testing threedimensional freehand ultrasound and instrumented spasticity assessment in people with Stroke and Spasticity, run by Universitaire Ziekenhuizen KU Leuven at 1 site in Belgium.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Poststroke spasticity significantly impairs function, particularly through the development of pes equinovarus. Botulinum toxin A (BoNT) injections into the medial gastrocnemius (MG) are a first-line treatment. Read more about this study

Who is it for?
Ages 40 to 60 years
Conditions the study is for
Stroke, Spasticity, Equinovarus Foot
What is being tested?
threedimensional freehand ultrasound and instrumented spasticity assessment
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
12 participants
Where
1 siteBelgium
Study dates
2 May 2025to 31 Dec 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 60 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Voluntary written informed consent of the participant or their legally authorized representative has been obtained prior to any screening procedures
  • 2. At least 18 years of age at the time of signing the Informed Consent Form (ICF)
  • 3. Use of highly effective methods of birth control; defined as those that, alone or in combination, result in low failure rate (i.e., less than 1% per year) when used consistently and correctly; such as implants, injectables, combined oral contraceptives, some IUDs, true sexual abstinence (i.e. refraining from heterosexual intercourse during the entire period of risk associated with the Trial treatment(s)) or commitment to a vasectomised partner.
  • 4. Pes equinovarus due to spasticity
  • 5. Clinical need for BoNT injection at the lower leg
  • 6. Any previous injection of BoNT into the muscles to be investigated was at least 3 months ago
  • 7. First-ever, unilateral stroke

Who cannot join

  • Musculoskeletal or other neurological problems affecting the lower limb
  • Presence of spinal cord pathology that could lead to spasticity, ataxia, dystonia
  • Cognitive problems that impede measurements
  • Severe co-morbidities
  • Irritated skin or open wounds where ultrasound will be placed
  • Pregnancy
Show all 9Show fewer
  • Profound atrophy of the muscles in the target area(s) of injection
  • Participation in an interventional Trial with an investigational medicinal product (IMP) or device
  • The effect of botulinum toxin A can theoretically be potentiated by agents affecting neuromuscular transmission, such as aminoglycoside antibiotics (e.g., gentamicin, tobramycin), lithium salts, cholinesterase inhibitors and tubocurarine-like muscle relaxants ((cis)atracurium, rocuronium, suxamethonium, vecuronium). Therefore, patients on whom these medications are started during the course of the trail will be excluded.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Fabienne Schillebeeckx, MD, PI contact

0032 - 16338714

fabienne.schillebeeckx@uzleuven.be

Fabienne Schillebeeckx, MD,PI contact

0495100300

fabienne.schillebeeckx@uzleuven.be

Belgium1 site, 1 recruiting
  • Uz Leuven

    Leuven, 3000

    Fabienne Schillebeeckx, MD, PhD, 0495100300, fabienne.schillebeeckx@uzleuven.be

    Recruiting

Other trials in Belgium

About this study

Official title: Exploratory, Longitudinal Study to Define Changes in Muscle, Tendon and Neural Properties After Botuline Neurotoxin Type A (BoNT) Treatment of Spastic Equinovarus in First-ever Stroke Patients: a Pilot Study.

Poststroke spasticity significantly impairs function, particularly through the development of pes equinovarus. Botulinum toxin A (BoNT) injections into the medial gastrocnemius (MG) are a first-line treatment. Treatment outcomes and long-term responses to interventions can vary significantly between individual patients. Additionally, there is increasing concern about potential adverse effects on muscle morphology. Further research is essential to optimize treatment strategies and improve long-term outcomes in this population. Three-dimensional freehand ultrasound (3DfUS) and instrumented spasticity assessment (ISA) are two recently developed techniques that enable the evaluation of changes in muscle, tendon, and neural properties following BoNT injections for post-stroke spastic equinovarus. These methods hold promise for providing new insights into treatment effects. Before implementing these techniques in large-scale studies, a pilot study is required for accurate sample size calculations for a prospective observational study. This study includes a protocol for a non-blinded, non-randomized open-label longitudinal pilot study. The study was approved by the European Medicines Agency ( EU CT Number 2024-513158-32) by the University Hospitals Leuven ethical committee (ID S68672). Standard deviations and effect sizes of outcome measures obtained longitudinally with 3DfUS and ISA before and after BoNT injection into MG will inform sample size calculations for future research.

Read the detailed description

TRIAL RATIONALE:

To conduct a pilot study as guidance for a future observational study to evaluate changes in muscle, tendon and neural properties after botulinum neurotoxin-A (BoNT) treatment of spastic equinovarus in first-ever stroke patients by using Three Dimensional freehand Ultrasound (3DfUS) and Instrumented Spasticity Assessment (ISA) with the aim of optimizing treatment algorithms and long-term response in this population.

TRIAL DESIGN:

Non-blinded, non-randomized open label, longitudinal pilot interventional clinical trial.

In total, 4 visits will be organised:

  1. V1: Baseline visit, week 0
  2. V2: Injection visit, week 5-7
  3. V3: Follow-up visit, week 10-12:
  4. V4: End of study visit , week 18-30

4 visits are organized according to the biological functioning of BoNT. These 4 visits also correspond to the standard clinical visits as they currently proceed when a patient is treated with BoNT. At baseline visit (week 0) and injection visit (week 6) we do not expect any changes in outcome parameters since no BoNT has been injected yet. The effect of BoNT has peak effects after 4-6 weeks and a duration of action between 2 and 6 months. At follow-up visit (week 10-12) and end-of-study visit (when BoNT is clinically elaborated, week 18-30) we expect corresponding changes in outcome parameters, respectively.

At each visit, 3DfUS measurements and ISA measurements will be performed on two muscles of both legs: 1) medial gastrocnemius muscle and 2) tibialis anterior muscle. The majority of US literature in the lower limb has focused on medial gastrocnemius. Additionally, these muscles are obvious candidates because of their functional importance in locomotion. Moreover, the medial gastrocnemius is a frequently injected muscle with BoNT, whereas tibialis anterior muscle is not. From a methodological perspective, both medial gastrocnemius and tibialis anterior are superficial and can be easily tracked by means of conventional US probes and EMG electrodes.

During visit 2, a pregnancy test will be conducted prior to the injection of Botulinum toxin. If the test is positive, the study will be discontinued, and the patient will not be treated with Botulinum toxin A.

Total duration of one visit will be 1.5 to 2 hours. All measurements of one visit take place on the same day. Measurements will be performed at the University Hospital Leuven.

For this study, stroke patients treated with BoNT for spastic equinovarus will be included. In particular stroke patients are patients that are being treated at the University Hospital, Leuven. The annual number of stroke patients seen in UZ Leuven is approximately 600 per year.

Being tested
threedimensional freehand ultrasound and instrumented spasticity assessment
Keywords
Botulinum Toxins, stroke, Medial Gastrocnemius Muscle, Skeletal muscle morphology, muscle composition
Medical subject headings
Stroke, Muscle Spasticity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • threedimensional freehand ultrasound and instrumented spasticity assessmentDiagnostic test

    To conduct a pilot study as guidance for a future observational study to evaluate changes in muscle, tendon and neural properties after botulinum neurotoxin-A (BoNT) treatment of spastic equinovarus in first-ever stroke patients by using Three Dimensional freehand Ultrasound (3DfUS) and Instrumented Spasticity Assessment (ISA) with the aim of optimizing treatment algorithms and long-term response in this population.

Study groups in NCT06767631
Study groupRoleWhat they receive
stroke patients treated with Botulinum toxine injections for spastic equinovarusOtherThis study involves a single-arm, exploratory, longitudinal design focusing on first-time stroke patients with spastic equinovarus deformity. Participants will receive Botulinum Neurotoxin Type A (BoNT-A) injections targeting medial and lateral gastrocnemius muscle as well ass soleus muscle. The intervention aims to assess changes in muscle, tendon, and neural properties before and after treatment by using instrumented spasticity assessment and threedimensional freehand ultrasound
Receives: Diagnostic Test: threedimensional freehand ultrasound and instrumented spasticity assessment

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. sample size calculation

    To estimate the number of subjects to calculate an appropriate sample size for assessing changes in muscle, tendon and neural properties after BoNT treatment of spastic equinovarus in first-ever stroke patients by using 3DfUS and ISA in a future observational study. To calculate standard deviation and effect sizes of outcome measures obtained with 3DfUS and ISA in these patients.

    Measured: 2 years

Secondary outcomes (28)
  1. muscle changes

    Secondary outcome parameters measured by 3DfUS include muscle belly length for medial gastrocnemius muscle

    Measured: 2 years

  2. neural changes

    Secondary outcome parameters measured by ISA for slow stretch measured by ISA : maximal velocity of performance (Vmax [deg/s])

    Measured: 2 years

  3. functional changes

    Medical baseline data including age, gender, body mass index, time since stroke, stroke etiology, National Institute Health Stroke Scale [15], affected side, oral medication and adverse events will be collected at each visit from the patients medical file as they are part of standard of care:

    Measured: 2 years

  4. muscle changes

    Secondary outcome parameters measured by 3DfUS include tendon length for medial gastrocnemius muscle

    Measured: 2 years

  5. muscle changes

    Secondary outcome parameters measured by 3DfUS include mid-belly cross-sectional area for medial gastrocnemius muscle

    Measured: 2 years

  6. muscle changes

    Secondary outcome parameters measured by 3DfUS include muscle belly length for tibial anterior muscle

    Measured: 2 years

  7. muscle changes

    Secondary outcome parameters measured by 3DfUS mid-belly cross-sectional area for tibial anterior muscle

    Measured: 2 years

  8. muscle changes

    Secondary outcome parameters measured by 3DfUS include mean Echo Intensity for tibial anterior muscle

    Measured: 2 years

  9. muscle changes

    Secondary outcome parameters measured by 3DfUS include mean Echo Intensity for medial gastrocnemius muscle

    Measured: 2 years

  10. neural changes

    Secondary outcome parameters measured by ISA for slow stretch measured by ISA : range of motion [deg]

    Measured: 2 years

  11. neural changes

    Secondary outcome parameters measured by ISA for slow stretch measured by ISA: stiffness [Nm/deg]

    Measured: 2 years

  12. neural changes

    Secondary outcome parameters measured by ISA for slow stretch measured by ISA work [J] (area under the power-time curve).

    Measured: 2 years

  13. neural changes

    Secondary outcome parameters measured by ISA from the fast stretch: maximal velocity of performance (Vmax [deg/s])

    Measured: 2 years

  14. neural changes

    Secondary outcome parameters measured by ISA from the fast stretch: joint angle of catch [deg]

    Measured: 2 years

  15. neural changes

    Secondary outcome parameters measured by ISA from the fast stretch: angle of EMG threshold [deg]

    Measured: 2 years

  16. neural changes

    Secondary outcome parameters measured by ISA from the fast stretch: intensity of catch (power [W]; torque times angular velocity).

    Measured: 2 years

  17. functional changes

    Modified Asworth Scale

    Measured: 2 years

  18. functional changes

    Tardieu scale

    Measured: 2 years

  19. functional changes

    Barthel Index

    Measured: 2 years

  20. functional changes

    Functional Ambulation Categories

    Measured: 2 years

  21. functional changes

    the Rivermead Mobility Index

    Measured: 2 years

  22. functional changes

    Functional Independence Measure

    Measured: 2 years

  23. functional changes

    Fugl-Meyer scale

    Measured: 2 years

  24. functional changes

    Modified Rankin Scale

    Measured: 2 years

  25. functional changes

    5 Meter Timed Walking Test

    Measured: 2 years

  26. functional changes

    Motricity Index

    Measured: 2 years

  27. functional changes

    Five-Times Sit-to-Stand Test

    Measured: 2 years

  28. functional changes

    Gait analyses

    Measured: 2 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Jan 2025
  2. Study start2 May 2025
  3. Primary completion31 May 2027 (estimated)
  4. Study completion31 Dec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
12 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06767631
Sponsor's protocol ID
S68672
Other IDs
Trial number 2024-513158-32-00
Status last verified
Apr 2026
First submitted
27 Dec 2024
Last updated
29 Apr 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Hanssen B, De Beukelaer N, Schless SH, Cenni F, Bar-On L, Peeters N, Molenaers G, Van Campenhout A, Van den Broeck C, Desloovere K. Reliability of Processing 3-D Freehand Ultrasound Data to Define Muscle Volume and Echo-intensity in Pediatric Lower Limb Muscles with Typical Development or with Spasticity. Ultrasound Med Biol. 2021 Sep;47(9):2702-2712. doi: 10.1016/j.ultrasmedbio.2021.04.028. Epub 2021 Jun 8.

    PubMed 34112554

Questions about this trial

What is this clinical trial studying?

A study testing threedimensional freehand ultrasound and instrumented spasticity assessment in people with Stroke and Spasticity, run by Universitaire Ziekenhuizen KU Leuven at 1 site in Belgium.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 29 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Fabienne Schillebeeckx, MD, PI (0032 - 16338714, fabienne.schillebeeckx@uzleuven.be), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

sample size calculation (time frame: 2 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06767631, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Apr 2026.

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Clinical Trial NCT06767631 | AzTrials