High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at?

Intiso, Domenico; Simone, Valentina; Bartolo, Michelangelo; Santamato, Andrea; Ranieri, Maurizio; Gatta, Maria Teresa; Rienzo, Filomena Di

doi:10.3390/toxins12050315

Cited by 19 publications

(14 citation statements)

References 76 publications

(146 reference statements)

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“…Self-reported pain in CCP is the primary determinator for diminished quality of life [ 4 , 5 ], [ 38 , 39 , 40 ]. In part 1 of this study, we were unable to detect an expected BoNT dose-dependent decrease in spasticity [ 41 , 42 , 43 , 44 , 45 ]. At first glance, this is unexpected because we usually assume a relationship between the dosing of BoNT and modulation/reduction of spasticity.…”

Section: Discussionmentioning

confidence: 77%

The Relationship between Pain and Spasticity and Tell-Tale Signs of Pain in Children with Cerebral Palsy

Wong

2023

Toxins

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Pain and quality of life are closely interrelated in children with cerebral palsy (CCP). Even though 67% of CCP experience pain, it is overlooked and untreated. In this study, our purpose was two-fold: first, to examine the relationship between pain and spasticity by evaluating the effects of AbobotulinumtoxinA/Dysport (BoNT), and second, to describe the symptoms and location of pain in CCP. The subjects were 22 CCP in at least moderate pain. They were evaluated for spasticity by the modified Ashworth and Tardieu scale and for pain by the r-FLACC and the pediatric pain profile. After one injection of BoNT, the subjects were re-evaluated. We found a significant reduction in pain, but no significant relationship between the reduction of pain and spasticity. We found no association between the dose of BoNT and pain or spasticity. Pain in the lower extremity was located primarily in the hip region. The effect of ultrasound-guided intermuscular injections of BoNT suggests that pain in CCP has an extra-articular component. We found that pain in CCP manifests as specific tell-tale signs and problems in daily living. In conclusion, we found no relationship between pain and spasticity. Signs and manifestations of pain are described in detail. Lower extremity (hip) pain seems to have a soft tissue/extra-articular component.

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Section: Discussionmentioning

confidence: 77%

The Relationship between Pain and Spasticity and Tell-Tale Signs of Pain in Children with Cerebral Palsy

Wong

2023

Toxins

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“…Botulinum toxin works by blocking neuromuscular junction transmission, and its effects generally last about 3 months. Dosing of botulinum toxin is done incrementally, and the recommended maximum total dose is 400 units every 3 months, although more recent studies have suggested safety and efficacy with higher dosages 10 . Consensus guidelines are available to help guide dosing based on indication and the targeted muscle 11 …”

Section: Spasticitymentioning

confidence: 99%

Symptomatic Treatment of Myelopathy

Chuang

2024

CONTINUUM: Lifelong Learning in Neurology

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Objective This article discusses the effects of myelopathy on multiple organ systems and reviews the treatment and management of some of these effects. Latest Developments Recent advances in functional electrical stimulation, epidural spinal cord stimulation, robotics, and surgical techniques such as nerve transfer show promise in improving function in patients with myelopathy. Ongoing research in stem cell therapy and neurotherapeutic drugs may provide further therapeutic avenues in the future. Essential Points Treatment for symptoms of spinal cord injury should be targeted toward patient goals. If nerve transfer for upper extremity function is considered, the patient should be evaluated at around 6 months from injury to assess for lower motor neuron involvement and possible time limitations of surgery. A patient with injury at or above the T6 level is at risk for autonomic dysreflexia, a life-threatening condition that presents with elevated blood pressure and can lead to emergent hypertensive crisis. Baclofen withdrawal due to baclofen pump failure or programming errors may also be life-threatening. Proper management of symptoms may help avoid complications such as autonomic dysreflexia, renal failure, heterotopic ossification, and fractures.

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“…This can allow patients to visit the hospital less frequently, thus minimizing the risk of exposure to SARS-CoV-2. In the literature, several recent publications suggest that higher incobotulinumtoxinA doses (>400 to 840 units) are safe and well-tolerated [ 22 , 26 , 27 , 28 , 29 ], while others do not rule out increased risks of systemic side effects [ 30 , 31 , 32 , 33 ]. Therefore, dosing has to be considered carefully by the treating physician, on a patient-by-patient basis, and must take into account the previously used dosing levels to assess how many doses could be increased without undue risk.…”

Section: Challenges and Recommendationsmentioning

confidence: 99%

Botulinum Toxin Services for Neurorehabiliation: Recommendations for Challenges and Opportunities during the COVID-19 Pandemic

Bavikatte

Jacinto

Deltombe

et al. 2021

Toxins

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The COVID-19 pandemic severely impacted the function of medical facilities and rehabilitation services worldwide, including toxin services delivering Botulinum toxin treatments for neuromuscular conditions such as spasticity, dystonia, and sialorrhea. The aim of this paper is to understand how toxin services have dealt with the situation and what strategies have been adopted to continue services. The recommendations are based on a virtual round table held with toxin services experts from different European countries who shared their experiences and discussed the best practices. The challenges for toxin services were reviewed based on the experts’ experiences and on relevant literature from 2020 and 2021. A set of recommendations and best practices were compiled, focusing firstly on guidance for clinical practice, including assessing patients’ health and risk status and the urgency of their treatment. Secondly, it was discussed how patients on botulinum toxin therapy can be cared for and supported during the pandemic, and how modern technology and tele-medicine platforms can be generally used to optimize effectiveness and safety of toxin treatments. The technological advances prompted by the COVID-19 crisis can result in better and more modern patient care in the future.

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High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at?

Cited by 19 publications

References 76 publications

The Relationship between Pain and Spasticity and Tell-Tale Signs of Pain in Children with Cerebral Palsy

The Relationship between Pain and Spasticity and Tell-Tale Signs of Pain in Children with Cerebral Palsy

Symptomatic Treatment of Myelopathy

Botulinum Toxin Services for Neurorehabiliation: Recommendations for Challenges and Opportunities during the COVID-19 Pandemic

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