Botulinum Toxin Type A and Physiotherapy in Spasticity of the Lower Limbs Due to Amyotrophic Lateral Sclerosis

Abstract

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease (unknown pathogenesis) of the central nervous system that causes death within 1–5 years. Clinically, flabby paralysis, areflexia, muscular atrophy, and muscle fasciculations, signs of II motor neuron damage, appear. Sometimes, clinical manifestations of damage of the I motor neuron come out in lower limbs; spastic paralysis, iperflexia, and clonus emerge, and they impair deambulation and management of activities of daily living, such as personal hygiene or dressing. Thus, the first therapeutic approach in these patients involves antispasmodic drugs orally followed by botulinum toxin type A injection (BTX-A). In this study, we study the efficacy of BTX-A and physiotherapy in lower limb spasticity due to ALS and no response to treatment with oral antispastic drugs. We evaluated 15 patients (10 male and five female), with a mean age of 48.06 ± 5.2 with spasticity of adductor magnus (AM), at baseline (T0, before BTX-A treatment) and in the following three follow-up visits (T1 30 days, T2 60 days, and T3 90 days after infiltration). We evaluated myometric measure of muscle tone, the Modified Ashworth Scale of AM, Barthel Index, Adductor Tone Rating Scale, and Hygiene Score. The study was conducted between November 2018 and April 2019. We treated AM with incobotulinum toxin type A (Xeomin®, Merz). Spasticity (myometric measurement, Adductor Tone Rating Scale, and Modified Ashworth Scale) and clinical (Barthel Index and Hygiene Score) improvements were obtained for 90 days after injection (p < 0.05). Our study shows the possibility of using BTX-A in the treatment of spasticity in patients with ALS and no response to oral antispastic drugs, with no side effects. The limitation of the study is the small number of patients and the limited time of observation; therefore, it is important to increase both the number of patients and the observation time in future studies.

Proposta Contemporânea Do Tratamento Da Espasticidade Em Pacientes Neurológicos Adulto: Uma Revisão Sistemática

“…O uso da TBA para a espasticidade de membros inferiores associado à Fisioterapia em pacientes com esclerose lateral amiotrófica (ELA) mostrou-se eficaz num estudo de Marvulli e colaboradores (2019) 24 . Neste estudo, pacientes com ELA apresentando espasticidade em membros inferiores sem resposta ao tratamento oral, apresentaram melhora da função motora de membros inferiores após três meses de aplicação da TBA em adutores de quadril associado à Fisioterapia.…”

Physical Exercises in Combination with Botulinum Toxin in Treating Children with Cerebral Palsy: A Literature Review

“…time period when injected locally, with high potentiality and reversible action [1]. The soul benefit of botulin administration in any condition is to reduce spasm, pain and inflammation and ameliorate patient condition [5].…”

“…Botulin neurotoxins is formed by toxins of the micro-organisms like Clostridium botulinum and Clostridium barati . Botulin neurotoxins are divided into seven distinguishable forms of animal antisera and selected in alphabetical order from A to G. Mechanism of action of botulin neurotoxin classified as: (1) Bond formation with nerve terminals (2) Abatement in bond of interchain disulphide [ 1 ]. Botulin act on nerve end plates to inhibit the release of neuropeptide and plays as an anti-inflammatory one [ 2 ].…”

“…Apart from neurological conditions botulin injections are also administered in several health conditions such as congenital torticollis, myofascial pain syndrome, knee osteoarthritis, myofascial pelvic pain, stroke, burn and Cerebral Palsy (CP) [ 4 ]. Botulin neurotoxin is considered to be a safe invasive treatment for humans as it has restricted diffusion time period when injected locally, with high potentiality and reversible action [ 1 ]. The soul benefit of botulin administration in any condition is to reduce spasm, pain and inflammation and ameliorate patient condition [ 5 ].…”

Terapi Farmakologi Nyeri pada Amyotrophic Lateral Sclerosis

“…BoNT akan menghambat pelepasan Ach pada neuromuscular junction melalui proses inaktivasi enzimatis pada protein yang dibutuhkan untuk proses docking dan fusi yang terlibat dalam pelepasan Ach [52][53][54] Dosis bergantung produk 52 Hepar: Tidak ada Renal: Tidak ada 52 Ruam dan kelemahan otot pada injection site, flu-like symptoms dan sakit kepala 54 Hipersensitif terhadap BoNT 54 seringkali menyertai pasien ALS. Terdapat dua jenis manifestasi klinis spastisitas yaitu, spastisitas tonik yang dapat menyebabkan terjadinya kekakuan otot dan spastisitas fasik yang menghasilkan kram disertai nyeri, kejang otot, dan klonus.…”