Botulinum toxin for the management of spasticity in multiple sclerosis: the Italian botulinum toxin network study
- PDF / 401,803 Bytes
- 12 Pages / 595.276 x 790.866 pts Page_size
- 104 Downloads / 203 Views
ORIGINAL ARTICLE
Botulinum toxin for the management of spasticity in multiple sclerosis: the Italian botulinum toxin network study Marcello Moccia 1,2 & Jessica Frau 3 & Antonio Carotenuto 1 & Calogera Butera 4 & Giancarlo Coghe 3 & Pierangelo Barbero 5,6 & Marco Frontoni 7 & Elisabetta Groppo 8 & Morena Giovannelli 9 & Ubaldo Del Carro 4 & Cristina Inglese 3 & Emma Frasson 10 & Anna Castagna 8 & Maria Buccafusca 11 & Pamela Latino 9 & Caterina Nascimbene 12 & Marcello Romano 13 & Vitalma Liotti 14 & Stefania Lanfranchi 15 & Laura Rapisarda 16 & Silvia Lori 17 & Marcello Esposito 18 & Loredana Maggi 19 & Martina Petracca 20,21 & Salvatore Lo Fermo 22 & Maria Concetta Altavista 23 & Francesco Bono 16 & Roberto Eleopra 24 & Vincenzo Brescia Morra 1 Received: 13 October 2019 / Accepted: 1 April 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background Botulinum toxin (BT) is an effective and safe treatment for spasticity, with limited evidence in multiple sclerosis (MS). We aim to describe the use of BT for the management of MS spasticity in the clinical practice, its combination with other anti-spastic treatments in MS and possible MS clinical correlates. Methods This is a multicentre cross-sectional observational study including 386 MS patients, receiving BT for spasticity in 19 Italian centres (age 53.6 ± 10.9 years; female 228 (59.1%); disease duration 18.7 ± 9.2 years; baseline Expanded Disability Status Scale (EDSS) 6.5 (2.0–9.0)). Results BT was used for improving mobility (n = 170), functioning in activities of daily living (n = 56), pain (n = 56), posturinghygiene (n = 63) and daily assistance (n = 41). BT formulations were AbobotulinumtoxinA (n = 138), OnabotulinumtoxinA (n = 133) and IncobotulinumtoxinA (n = 115). After conversion to unified dose units, higher BT dose was associated with higher EDSS (Coeff = 0.591; p < 0.001), higher modified Ashworth scale (Coeff = 0.796; p < 0.001) and non-ambulatory patients (Coeff = 209.382; p = 0.006). Lower BT dose was used in younger patients (Coeff = − 1.746; p = 0.009), with relapsingremitting MS (Coeff = − 60.371; p = 0.012). BT dose was higher in patients with previous BT injections (Coeff = 5.167; p = 0.001), and with concomitant treatments (Coeff = 43.576; p = 0.022). Three patients (0.7%) reported on post-injection temporary asthenia/weakness (n = 2) and hypophonia (n = 1). Conclusion BT was used for spasticity and its consequences from the early stages of MS, without significant adverse effects. MSspecific goals and injection characteristics can be used to refer MS patients to BT treatment, to decide for the strategy of BT injections and to guide the design of future clinical trials and observational studies. Keywords Multiple sclerosis . Spasticity . Botulinum . Symptomatic treatment
Introduction Maria Concetta Altavista, Francesco Bono, Roberto Eleopra and Vincenzo Brescia Morra contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10072-020-04392-8) contains suppl
Data Loading...
