Improvements in healthcare and cost benefits associated with botulinum toxin treatment of spasticity and muscle overactivity

Abstract

Spasticity is a widespread, disabling form of muscle overactivity affecting patients with central nervous system damage resulting in upper motor neurone syndrome. There is a range of effective therapies for the treatment of spasticity (e.g. physical, anaesthetic, chemodenervation and neurolytic injections, systemic medication and surgery), but all therapies must be based on an individualized, multidisciplinary programme targeted to achieve patient goals. Appropriate therapy should be based on the extent and severity of spasticity, but spasticity and its consequences, regardless of presentation or cause, are commonly treated with systemic agents. This may be ill-advised as systemic treatment is associated with many undesirable effects. In particular, elderly patients with post-stroke spasticity are at risk from the central adverse effects of systemic medication (e.g. sedation and gait disturbance), which make them more susceptible to falling, with an associated increased risk of fracture. The rising costs of fracture care and its sequelae are fast becoming an international problem contributing to high healthcare expenditure. Botulinum toxin type-A (BoNT-A) treatment is highly effective for some of the more common forms of spasticity and muscle overactivity, and has a favourable profile when compared with systemic agents and other focal treatments. Therefore, the clinical benefits of BoNT-A treatment outweigh the apparent high costs of this intervention, showing it to be a cost-effective treatment.

OnabotulinumtoxinA muscle injection patterns in adult spasticity: a systematic literature review

“…While spasticity following stroke is common, spasticity can also occur in adults following traumatic brain injury, multiple sclerosis, spinal cord injury, and, on some occasions, degenerative central nervous system disorders [2,3]. Spasticity is often classified according to the distribution of body regions affected, which may be focal, regional, or generalized [4,5]. Focal spasticity affects an isolated body part such as the elbow or foot, whereas regional spasticity can affect an entire limb and generalized spasticity affects multiple body areas.…”

“…Numerous treatments are used to reduce spasticity. Botulinum neurotoxin (BoNT) injections are employed as a focal antispastic agent, usually as part of a broader rehabilitation regimen [4]. In the development of an overall treatment plan, consideration should be given to the treatment goals, including the balance between reduction of spastic hypertonia and preservation of residual motor strength and function [13].…”

Botulinum neurotoxins for post‐stroke spasticity in adults: A systematic review

“…Botulinum neurotoxin (BoNT) injections are employed as focal antispastic agents usually as part of complex rehabilitation regimens. 4 Treatment plans must consider a trade-off between reduction of spastic hypertonia and preservation of residual motor function. 5 Active function relates to the capacity to move the body or its parts actively and can range from simple active movements at a specified joint to complex movements and even complex actions; passive function relates to the ability to integrate a body part in activities passively.…”

Botulinum Neurotoxin: The Ugly Duckling

“…One of the main reasons for this skepticism is the justified uncertainty about the long-term therapeutic potential of the drug [100] as well as immunobiological concerns [101, 102] and the cost of botulinum toxin treatment [103]. The experimental clinical studies carried out so far to test the efficacy of botulinum neurotoxins in various pathological circumstances are not considered fully reliable on universal standards.…”