COVID-19-related delays of botulinum toxin injections have a negative impact on the quality of life of patients with dystonia and spasticity: a single-center ambulatory care study

Abstract

Background Botulinum toxin A (BoNT-A) is considered a safe and effective treatment for spasticity and dystonia. Individual interinjection intervals are critical for the maintenance of the effect. In Austria, BoNT outpatient clinics were shutdown from November to December 2020 during COVID-19 control measures, leading to rescheduling of BoNT-A injections. This survey aimed at investigating the influence of injection delays on symptoms, physical functioning, and quality of life (QoL) of the affected patients. Methods Between April and July 2021, 32 outpatients (21 females, mean age: 63.4 ± 12.1 years) treated ≥ 12 months at the BoNT outpatient clinic Horn-Allentsteig (Austria) and experienced ≥ 2 week injection delays, completed a structured face-to-face questionnaire. Results Indications were dystonia (34%), spasticity (63%), and hyperhidrosis (3%). Injections were delayed by 10 weeks (median, range: 2–15). Muscle cramps increased in 95% of patients with spasticity, muscle twitches in 91% of those with dystonia, and pain in 9% and 60% for dystonia and spasticity, respectively. Overall, 75% reported functional worsening, and deterioration in QoL by 62.6% ± 16.8 (mean ± SD). The impact on QoL correlated with the subjective global improvement induced by BoNT-A (Rs: 0.625; p < 0.001). For 75%, long-term assurance of BoNT-A therapy was very important, and 81% felt their patient rights not respected. Conclusions COVID-19-related delays in BoNT-A injections illustrate the importance of this therapy for symptom relief, functional outcome, and QoL in patients suffering from involuntary muscle hyperactivity. BoNT-A therapy is essential and has to be guaranteed even in circumstances such as the COVID-19 pandemic.

The Impact of COVID-19 on Hyperhidrosis Patients in the Mental Health and Quality of Life: A Web-Based Surveillance Study

“…This contradicts other medical or dermatological conditions that were impacted significantly due to measures to prevent the spread of SARS-CoV-2. Due to restrictions or impacts of the pandemic, patients experienced functional impairment in their quality of life [28]; marked reduction of face-to-face consultations, especially in dermatology [29]; delayed or under-reported diagnosis of skin malignancy [30]; and even decrease in urgent visit for dermatologic conditions [31]. However, this study showed that these kinds of impacts were not serious among hyperhidrosis patients; even the reduction in the outpatient visit might not be recognizable.…”

Management of spasticity in individuals with spinal cord injury in the era of COVID-19 pandemic societal restrictions

“…In addition to many elective procedures, BoNT-A injections were postponed [ 2 ], which caused a loss of function due to increased spasticity in individuals with disabilities [ 10 ]. During the COVID-19 pandemic, the effects of disruptions in accessing health services and discontinuation of BoNT-A treatment in patients with spasticity due to stroke, traumatic brain injury, cerebral palsy, and dystonia have been investigated [ 11 – 13 ]. However, to our knowledge, this is the first study to specifically focus on individuals with SCI.…”

The COVID‐19 pandemic and its consequences for chronic pain: a narrative review

“…In many cases, pain catastrophising or anxiety was linked to greater perceived severity of pain during the pandemic [78,81]. Although widespread adoption of telemedicine facilitated healthcare access, patients with higher pain burden or level of anxiety were found to be less accepting of telemedicine [82] and patients who also had delays or cancellations of interventions were more likely to report increased pain [83,84]. There was a substantial increase in opioid overdose deaths in the United States and Canada during the pandemic [5,85], but it is not clear if opioid prescriptions to pain patients was contributory.…”