Treatment of spasticity in spinal cord injury with botulinum toxin

Palazón-García, Ramiro; Alcobendas-Maestro, M.; Ruz, A Esclarín-De; Benavente-Valdepeñas, Ana María

doi:10.1080/10790268.2018.1479053

Cited by 29 publications

(21 citation statements)

References 43 publications

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“…It has been considered in the last 20 years that BoNT should be indicated for people with motor incomplete SCI (ASIA Impairment Scale grades C or D according to the International Standard Neurological Classification of SCI) because this is the condition where focal spasticity is most likely to develop, despite the fact that there was a lack of publications on the use of BoNT for SCI [ 57 ]. The largest study collected data from 90 treated patients, and it showed that BoNT/A was more effective in focal spasticity in patients with AIS D, especially if they were injected for the first time in the first 6 months of evolution, and the improvement was established in terms of a decrease in tone, pain, and joint limitations and functional improvement [ 58 ]. Systematic reviews had previously been carried out on reported cases of SCI spasticity, which were either isolated cases or mixed spastic cases due to other causes [ 34 , 59 ].…”

Section: Treatment Of Spasticity In Spinal Cord Injury With Botulinum Toxinmentioning

confidence: 99%

“…In addition, it must be considered that in children below 12 years old, there are dose limits that we cannot exceed and that the first injection we make must use 50% of the estimated dose to avoid side effects due to the patient’s special predisposition. There are maximum total doses allowed for each toxin; however, due to the characteristics of the spasticity of SCI, these limits are usually exceeded [ 46 , 58 ]. The maximum doses and the recommended doses for the most frequent cases are shown in Table 3 ; they are based on previous studies and protocols, but not even the clinical trial can provide evidence for those indications and dosages [ 46 , 56 , 58 ].…”

Section: Treatment Of Spasticity In Spinal Cord Injury With Botulinum Toxinmentioning

confidence: 99%

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Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury

Palazón-García

Benavente-Valdepeñas

2021

IJMS

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Botulism has been known for about three centuries, and since its discovery, botulinum toxin has been considered one of the most powerful toxins. However, throughout the 20th century, several medical applications have been discovered, among which the treatment of spasticity stands out. Botulinum toxin is the only pharmacological treatment recommended for spasticity of strokes and cerebral palsy. Although its use as an adjuvant treatment against spasticity in spinal cord injuries is not even approved, botulinum toxin is being used against such injuries. This article describes the advances that have been made throughout history leading to the therapeutic use of botulinum toxin and, in particular, its application to the treatment of spasticity in spinal cord injury.

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Section: Treatment Of Spasticity In Spinal Cord Injury With Botulinum Toxinmentioning

confidence: 99%

Section: Treatment Of Spasticity In Spinal Cord Injury With Botulinum Toxinmentioning

confidence: 99%

Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury

Palazón-García

Benavente-Valdepeñas

2021

IJMS

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“…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

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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.

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“…In post-traumatic SCI, a prevalence between 60% and 80% has been reported and 35% had severe spasticity [65,66]. Although spasticity is a common disorder following SCI, few investigations have been performed to analyse the effect of BTX-A [67,68] and no studies have investigated high dose BTX-A in reducing spasticity in subjects with SCI.…”

Section: Spinal Cord Injurymentioning

confidence: 99%

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

Intiso

Simone

Bartolo³

et al. 2020

Toxins

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Spasticity is a common disabling disorder in adult subjects suffering from stroke, brain injury, multiple sclerosis (MS) and spinal cord injury (SCI). Spasticity may be a disabling symptom in people during rehabilitation and botulinum toxin type A (BTX-A) has become the first-line therapy for the local form. High BTX-A doses are often used in clinical practice. Advantages and limitations are debated and the evidence is unclear. Therefore, we analysed the efficacy, safety and evidence for BTX-A high doses. Studies published from January 1989 to February 2020 were retrieved from MEDLINE/PubMed, Embase, Cochrane Central Register. Only obabotulinumtoxinA (obaBTX-A), onabotulinumtoxinA (onaBTX-A), and incobotulinumtoxinA (incoBTX-A) were considered. The term “high dosage” indicated ≥ 600 U. Thirteen studies met the inclusion criteria. Studies had variable method designs, sample sizes and aims, with only two randomised controlled trials. IncoBTX-A and onaBTX-A were injected in three and eight studies, respectively. BTX-A high doses were used predominantly in treating post-stroke spasticity. No studies were retrieved regarding treating spasticity in MS and SCI. Dosage of BTX-A up to 840 U resulted efficacious and safety without no serious adverse events (AEs). Evidence is insufficient to recommend high BTX-A use in clinical practice, but in selected patients, the benefits of high dose BTX-A may be clinically acceptable.

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Treatment of spasticity in spinal cord injury with botulinum toxin

Abstract: BT can be both an effective treatment for focal spasticity in SCI and a good coadjuvant for oral treatments in generalized spasticity.

Cited by 29 publications

References 43 publications

Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury

Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury

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

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

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