Neuropathic pruritus is a form of chronic itch that occurs in the presence of direct damage to the nervous system. It tends to be severe, disabling, and difficult to treat. Usual antipruritic medications are largely ineffective and there is no consensus regarding the treatment approach. The authors report a case of a 58-year-old man with primary progressive multiple sclerosis and a history of unsatisfactory management of severe bilateral focal pruritus. Significant symptom relief was attained after local intradermal injections of botulinum toxin type A.
Introduction: The COVID-19 pandemic has imposed an additional pressure on health systems worldwide, creating an increased challenge to chronic patient management due to consultation shutdown. Spastic patients were especially vulnerable to inadequate care. This review aims to describe the impact of botulinum toxin (BT) consultation interruption due to the COVID-19 pandemic on spasticity treatment. Methods: A literature search was conducted in the database of Medline, PubMed, Embase, Google Scholar and Scopus. Keywords for the search included “COVID-19” AND “Botulinum Toxin” AND “Spasticity”. Results: A total of 6 studies reporting the impact of BT consultation suspension on spasticity due to the COVID-19 pandemic met inclusion criteria. All studies were observational and included a small sample. Consultation interruption was variable between studies and ranged from 36-75 days, originating a mean treatment delay of 23-129 days due to re-scheduling difficulties. The majority (72-93%) of patients in all studies perceived worsening of spasticity with BT consultation suspension. Effects seem to be worse with longer treatment delays and concerning the mobility and passive function treatment objectives. Some studies reported a worse quality of life in patients with BT treatment delay whilst others did not find this association. Discussion: Although a year has passed since the start of the COVID-19 pandemic, there is a scarcity of studies reporting the impact of BT consultation interruption on the treatment of spastic patients. An increased inter-treatment delay originates a reduction in the effectiveness at the end of the treatment cycle due BT washout. On average, a 1% worsening of symptoms occurs with one day of delay. Thus, a small delay of a few weeks can lead to worsening of symptoms which may take several treatment cycles to return to previous stable benefit level. The impact of BT consultation suspension on quality of life is controversial and further studies are necessary to clarify this question. Conclusions: The COVID-19 pandemic has had a major negative impact on the BT treatment of spasticity. Thus, consultation shutdown severely affected these patients and needs to be avoided.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.