The Use of Botulinum Toxin for Treatment of Spasticity

Li, Sheng; Francisco, Gerard E.

doi:10.1007/164_2019_315

Cited by 22 publications

(16 citation statements)

References 119 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It should be noted that not all patients who did not respond to BoNT-A therapy had high NAB levels, and some patients with high NAB levels still responded to BoNT-As [ 48 ]. The current results add to the growing body of evidence that incobotulinumtoxinA may carry less risk of inducing an immunogenic response relative to other BoNT-As – and hence less risk of nonresponse to therapy – because it is a highly purified formulation of BoNT-A [ 48 ] that does not contain BoNT-A accessory proteins [ 18 ]. For this reason, it may be the preferred choice for a chronic condition in a pediatric population [ 50 ].…”

Section: Discussionmentioning

confidence: 92%

“…Despite using an incobotulinumtoxinA dose of up to 400 U and repeated treatments, no secondary nonresponse to treatment due to NABs occurred. This is of importance for the anticipated long-term treatment of spastic CP as a chronic condition occurring in young patients [ 18 ]. In a study of BoNT-A use in patients with a variety of neurological impairments, 13.9% of 596 patients developed measurable NABs [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…An individualized, multilevel, multipattern focal treatment approach to target specific muscle groups, especially those underlying particular functional deficits, can help address the diverse clinical presentation of spasticity in children with CP [ 18 , 19 ]. Botulinum neurotoxin type A (BoNT-A) is a recommended therapy for pediatric spasticity [ 20 , 21 , 22 , 23 , 24 ] that has been demonstrated to be effective and well-tolerated and can be well integrated in such a multimodal, multiprofessional, interdisciplinary treatment approach [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

IncobotulinumtoxinA for the treatment of lower-limb spasticity in children and adolescents with cerebral palsy: A phase 3 study1

Heinen

Kaňovský

Schröeder

et al. 2021

PRM

View full text Add to dashboard Cite

PURPOSE: Investigate the efficacy and safety of multipattern incobotulinumtoxinA injections in children/adolescents with lower-limb cerebral palsy (CP)-related spasticity. METHODS: Phase 3 double-blind study in children/adolescents (Gross Motor Function Classification System – Expanded and Revised I–V) with unilateral or bilateral spastic CP and Ashworth Scale (AS) plantar flexor (PF) scores ⩾ 2 randomized (1:1:2) to incobotulinumtoxinA (4, 12, 16 U/kg, maximum 100, 300, 400 U, respectively) for two 12- to 36-week injection cycles. Two clinical patterns were treated. Pes equinus (bilateral or unilateral) was mandatory; if unilateral, treatment included flexed knee or adducted thigh. Endpoints: Primary: AS-PF change from baseline to 4 weeks; Coprimary: investigator-rated Global Impression of Change Scale (GICS)-PF at 4 weeks; Secondary: investigator’s, patient’s, and parent’s/caregiver’s GICS, Gross Motor Function Measure-66 (GMFM-66). RESULTS: Among 311 patients, AS-PF and AS scores in all treated clinical patterns improved from baseline to 4-weeks post-injection and cumulatively across injection cycles. GICS-PF and GICS scores confirmed global spasticity improvements. GMFM-66 scores indicated better motor function. No significant differences between doses were evident. Treatment was well-tolerated, with no unexpected treatment-related adverse events or neutralising antibody development. CONCLUSION: Children/adolescents with lower-limb spasticity experienced multipattern benefits from incobotulinumtoxinA, which was safe and well-tolerated in doses up to 16 U/kg, maximum 400 U.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

IncobotulinumtoxinA for the treatment of lower-limb spasticity in children and adolescents with cerebral palsy: A phase 3 study1

Heinen

Kaňovský

Schröeder

et al. 2021

PRM

View full text Add to dashboard Cite

show abstract

“…Another indication would be that of strabismus. It can sometimes be relieved by the weakening that causes the administration of the toxin so that the muscles adapt to the length corrected over time [54][55][56][57][58][59][60]. In fact, if a paralyzed muscle is stretched by its competitor, it increases more, while the competitor decreases and therefore over time, both eyes align, and this leads to a correct alignment between the two eyes.…”

Section: Pharmacological and Therapeutics Aspectsmentioning

confidence: 99%

Botulinum Neurotoxins (BoNTs) and Their Biological, Pharmacological, and Toxicological Issues: A Scoping Review

et al. 2021

View full text Add to dashboard Cite

Botulinum toxins or neurotoxins (BoNTs) are the most potent neurotoxins known, and are currently extensively studied, not only for their potential lethality, but also for their possible therapeutic and cosmetic uses. Currently, seven types of antigenically distinct toxins are known and characterized, produced by a rod-shaped bacterium, Clostridium botulinum. Human poisoning by botulism (presenting with severe neuromuscular paralytic disease) is usually caused by toxins A, B, E, and F type. Poisoning from contaminated food preparations is the most common cause of noniatrogenic botulism. The spores are highly resistant to heat but are easily destroyed at 80 °C for thirty minutes. Type A and B toxins are resistant to digestion by the enzymes of the gastrointestinal system. After their entry, BoNTs irreversibly bind to cholinergic nerve endings and block the release of acetylcholine from the synapses. In contrast, in wound botulism, the neurotoxin is instead product by the growth of C.botulium in infected tissues. The contamination by BoNT inhalation does not occur by a natural route but it is certainly the most dangerous. It can be caused by the dispersion of the botulinum toxin in the atmosphere in the form of an aerosol and therefore can be deliberately used for bioterrorist purposes (e.g., during CBRN (chemical, biological, radiological, and nuclear) unconventional events). In addition, BoNTs are currently used to treat a variety of diseases or alleviate their symptoms, such as the onabotulinumtoxinA for migraine attacks and for cosmetic use. Indeed, this paper aims to report on updated knowledge of BoNTs, both their toxicological mechanisms and their pharmacological action.

show abstract

“…Another established therapeutic use of botulinum toxin in SCI regards the pharmacological therapy of spasticity, a complication often associated with spinal trauma characterized by an abnormal muscle contraction of the limbs [108][109][110][111]. Injection of BoNT/A on specific muscles has been reported to improve mobility by counteracting spasticity in patients with spinal cord lesions [112][113][114][115][116].…”

Section: Botulinum Toxin and Spinal Cord Injuriesmentioning

confidence: 99%

Botulinum Toxin and Neuronal Regeneration after Traumatic Injury of Central and Peripheral Nervous System

Luvisetto

2020

Toxins

View full text Add to dashboard Cite

Botulinum neurotoxins (BoNTs) are toxins produced by the bacteria Clostridium botulinum, the causing agent for botulism, in different serotypes, seven of which (A–G) are well characterized, while others, such as H or FA, are still debated. BoNTs exert their action by blocking SNARE (soluble N-ethylmale-imide-sensitive factor-attachment protein receptors) complex formation and vesicle release from the neuronal terminal through the specific cleavage of SNARE proteins. The action of BoNTs at the neuromuscular junction has been extensively investigated and knowledge gained in this field has set the foundation for the use of these toxins in a variety of human pathologies characterized by excessive muscle contractions. In parallel, BoNTs became a cosmetic drug due to its power to ward off facial wrinkles following the activity of the mimic muscles. Successively, BoNTs became therapeutic agents that have proven to be successful in the treatment of different neurological disorders, with new indications emerging or being approved each year. In particular, BoNT/A became the treatment of excellence not only for muscle hyperactivity conditions, such as dystonia and spasticity, but also to reduce pain in a series of painful states, such as neuropathic pain, lumbar and myofascial pain, and to treat various dysfunctions of the urinary bladder. This review summarizes recent experimental findings on the potential efficacy of BoNTs in favoring nerve regeneration after traumatic injury in the peripheral nervous system, such as the injury of peripheral nerves, like sciatic nerve, and in the central nervous system, such as spinal cord injury.

show abstract

The Use of Botulinum Toxin for Treatment of Spasticity

Cited by 22 publications

References 119 publications

IncobotulinumtoxinA for the treatment of lower-limb spasticity in children and adolescents with cerebral palsy: A phase 3 study1

IncobotulinumtoxinA for the treatment of lower-limb spasticity in children and adolescents with cerebral palsy: A phase 3 study1

Botulinum Neurotoxins (BoNTs) and Their Biological, Pharmacological, and Toxicological Issues: A Scoping Review

Botulinum Toxin and Neuronal Regeneration after Traumatic Injury of Central and Peripheral Nervous System

Contact Info

Product

Resources

About