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01-10-2020 | Multiple Sclerosis | Original Article

Botulinum toxin for the management of spasticity in multiple sclerosis: the Italian botulinum toxin network study

Authors: Marcello Moccia, Jessica Frau, Antonio Carotenuto, Calogera Butera, Giancarlo Coghe, Pierangelo Barbero, Marco Frontoni, Elisabetta Groppo, Morena Giovannelli, Ubaldo Del Carro, Cristina Inglese, Emma Frasson, Anna Castagna, Maria Buccafusca, Pamela Latino, Caterina Nascimbene, Marcello Romano, Vitalma Liotti, Stefania Lanfranchi, Laura Rapisarda, Silvia Lori, Marcello Esposito, Loredana Maggi, Martina Petracca, Salvatore Lo Fermo, Maria Concetta Altavista, Francesco Bono, Roberto Eleopra, Vincenzo Brescia Morra

Published in: Neurological Sciences | Issue 10/2020

Abstract

Background

Botulinum toxin (BT) is an effective and safe treatment for spasticity, with limited evidence in multiple sclerosis (MS). We aim to describe the use of BT for the management of MS spasticity in the clinical practice, its combination with other anti-spastic treatments in MS and possible MS clinical correlates.

Methods

This is a multicentre cross-sectional observational study including 386 MS patients, receiving BT for spasticity in 19 Italian centres (age 53.6 ± 10.9 years; female 228 (59.1%); disease duration 18.7 ± 9.2 years; baseline Expanded Disability Status Scale (EDSS) 6.5 (2.0–9.0)).

Results

BT was used for improving mobility (n = 170), functioning in activities of daily living (n = 56), pain (n = 56), posturing-hygiene (n = 63) and daily assistance (n = 41). BT formulations were AbobotulinumtoxinA (n = 138), OnabotulinumtoxinA (n = 133) and IncobotulinumtoxinA (n = 115). After conversion to unified dose units, higher BT dose was associated with higher EDSS (Coeff = 0.591; p < 0.001), higher modified Ashworth scale (Coeff = 0.796; p < 0.001) and non-ambulatory patients (Coeff = 209.382; p = 0.006). Lower BT dose was used in younger patients (Coeff = − 1.746; p = 0.009), with relapsing-remitting MS (Coeff = − 60.371; p = 0.012). BT dose was higher in patients with previous BT injections (Coeff = 5.167; p = 0.001), and with concomitant treatments (Coeff = 43.576; p = 0.022). Three patients (0.7%) reported on post-injection temporary asthenia/weakness (n = 2) and hypophonia (n = 1).

Conclusion

BT was used for spasticity and its consequences from the early stages of MS, without significant adverse effects. MS-specific goals and injection characteristics can be used to refer MS patients to BT treatment, to decide for the strategy of BT injections and to guide the design of future clinical trials and observational studies.

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Title: Botulinum toxin for the management of spasticity in multiple sclerosis: the Italian botulinum toxin network study
Authors: Marcello Moccia
Jessica Frau
Antonio Carotenuto
Calogera Butera
Giancarlo Coghe
Pierangelo Barbero
Marco Frontoni
Elisabetta Groppo
Morena Giovannelli
Ubaldo Del Carro
Cristina Inglese
Emma Frasson
Anna Castagna
Maria Buccafusca
Pamela Latino
Caterina Nascimbene
Marcello Romano
Vitalma Liotti
Stefania Lanfranchi
Laura Rapisarda
Silvia Lori
Marcello Esposito
Loredana Maggi
Martina Petracca
Salvatore Lo Fermo
Maria Concetta Altavista
Francesco Bono
Roberto Eleopra
Vincenzo Brescia Morra
Publication date: 01-10-2020
Publisher: Springer International Publishing
Keywords: Multiple Sclerosis
Botulinum Toxin
Published in: Neurological Sciences / Issue 10/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-020-04392-8

At a glance: The STEP trials

Springer Medicine

Botulinum toxin for the management of spasticity in multiple sclerosis: the Italian botulinum toxin network study

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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