“Appropriate Treatment” and Therapeutic Window in Spasticity Treatment with IncobotulinumtoxinA: From 100 to 1000 Units

Ianieri, Giancarlo; Marvulli, Riccardo; Gallo, Giulia; Fiore, Pietro; Megna, Marisa

doi:10.3390/toxins10040140

Cited by 10 publications

(21 citation statements)

References 30 publications

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“…In this study, 155 subjects were enrolled, but only 11 (7.1%) suffered from traumatic brain injury [38]. The remaining two investigations did not report the number of spastic subjects according to aetiology [39] or spasticity aetiology [29]. Since these studies had mixed samples, the investigation by Ianieri et al was described in the stroke paragraph and that by Kirshblum et al was reported in the paragraph concerning studies with mixed samples.…”

Section: Brain Injurymentioning

confidence: 97%

“…The group treated by incoBTX-A > 700 U was injected by progressively increasing dosages, with a mean dose between 775.65 ± 30.45 and 986.65 ± 13.67 U. Transient general weakness was observed in 4% of subjects [39].…”

Section: Incobotulinumtoxina (Xeomin)mentioning

confidence: 99%

“…It was not possible to calculate the global number of treated patients, since one study with mixed samples did not report aetiologies of spasticity [39]; however, it was estimated that about 200 patients with PSS were injected with high dose incoBTX-A.…”

Section: Incobotulinumtoxina (Xeomin)mentioning

confidence: 99%

“…Although subjects suffering from spasticity following brain injury may show complex features and multi-level muscle involvement, few studies have investigated the efficacy and safety of high dose BTX-A. The literature research produced 246 citations, but only 4 studies were included [12,38,39,43]. The studies had variable method designs and enrolled mixed samples including patients with spasticity following several disorders affecting the CNS, including brain injury, stroke and cerebral palsy (CP).…”

Section: Brain Injurymentioning

confidence: 99%

“…The optimal dose for treating hip adductor spasticity was considered 500-1000 U of aboBTX-A, but the higher dose of 1500 U was suggested to provide greater benefit and was safe without major side effects [52]. Among BTX-A formulations, aboBTX-A and onaBTX-A were predominantly injected to treat spasticity, apart from in one study with mixed samples that used incoBTX-A [39] neurotoxin. All studies showed a significant efficacy of BTX in reducing spasticity due to MS [47][48][49].…”

Section: Multiple Sclerosismentioning

confidence: 99%

See 4 more Smart Citations

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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Section: Brain Injurymentioning

confidence: 97%

Section: Incobotulinumtoxina (Xeomin)mentioning

confidence: 99%

Section: Incobotulinumtoxina (Xeomin)mentioning

confidence: 99%

Section: Brain Injurymentioning

confidence: 99%

Section: Multiple Sclerosismentioning

confidence: 99%

See 3 more Smart Citations

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

View full text Add to dashboard Cite

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Bilateral and asymmetrical contributions of passive and active ankle plantar flexors stiffness to spasticity in humans with spinal cord injury

Chen

Sangari

Lorentzen

et al. 2020

Journal of Neurophysiology

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Spasticity is one of the most common symptoms present in humans with spinal cord injury (SCI), however, its clinical assessment remains underdeveloped. The purpose of the study was to examine the contribution of passive muscle stiffness and active spinal reflex mechanisms to clinical outcomes of spasticity after SCI. It is important that passive and active contributions to increased muscle stiffness are distinguished to make appropriate decisions about anti-spastic treatments and to monitor its effectiveness. To address this question, we combined biomechanical and electrophysiological assessments of ankle plantarflexor muscles bilaterally in individuals with and without chronic SCI. Spasticity was assessed using the Modified Ashworth Scale (MAS) and a self-reported questionnaire. We performed slow and fast dorsiflexion stretches of the ankle joint to measure passive muscle stiffness and reflex-induced torque using a dynamometer and the soleus H-reflex using electrical stimulation over the posterior tibial nerve. All SCI participants reported the presence of spasticity. While 96% of them reported higher spasticity on one side compared with the other, the MAS detected differences across sides in only 25% of the them. Passive muscle stiffness and the reflex-induced torque were larger in SCI compared with controls more on one side compared with the other. The soleus stretch reflex, but not the H-reflex, was larger in SCI compared with controls and showed differences across sides, with a larger reflex in the side showing a higher reflex-induced torque. MAS scores were not correlated with biomechanical and electrophysiological outcomes. These findings provide evidence for bilateral and asymmetric contributions of passive and active ankle plantar flexors stiffness to spasticity in humans with chronic SCI and highlight a poor agreement between a self-reported questionnaire and the MAS for detecting asymmetries in spasticity across sides.

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Real Life Experience with Individualized Doses of Incobotulinumtoxina in Patients with Severe Spasticity Due to Acquired Brain Injury

Al-nisr

Alguacil²

2022

MRAJ

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The objective of the present study was to evaluate the effectiveness and tolerability of incobotulinumtoxinA, at doses according to individual needs, in 10 patients with acquired brain injury and severe upper and lower limb spasticity. Patients received a multipattern periodic treatment with ultrasound-guided injections of incobotulinumtoxinA at doses of 800-900 U in the upper and lower limbs. The mean number of injection cycles per patient was 4.2. The 0-10 visual analogue scale for pain score decreased significantly from pre-injection (mean: 4.7) to four-week post-injection (mean: 0.7). Similarly, the mean Ashworth Scale score (muscular tone assessment) at four-week post-injection (mean: 1.4) was significantly lower than at injection (mean: 2.5). Except for two patients in one pattern, all cases showed an improvement in passive range of motion assessments using goniometry. All patients reported maximum satisfaction with the treatment, all reporting “much improved” after the treatment. No treatment-related adverse effects were observed during the study. Individualized doses of incobotulinumtoxinA are effective and well-tolerated for this type of patients and allow better management of their severe spasticity. Therefore, individualization of doses should be taken into account for optimizing clinical outcomes and improving the patients’ treatment satisfaction.

show abstract

“Appropriate Treatment” and Therapeutic Window in Spasticity Treatment with IncobotulinumtoxinA: From 100 to 1000 Units

Cited by 10 publications

References 30 publications

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

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

Bilateral and asymmetrical contributions of passive and active ankle plantar flexors stiffness to spasticity in humans with spinal cord injury

Real Life Experience with Individualized Doses of Incobotulinumtoxina in Patients with Severe Spasticity Due to Acquired Brain Injury

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