Discontinuation of botulinum neurotoxin type-A treatment during COVID-19 pandemic: an Italian survey in post stroke and traumatic brain injury patients living with spasticity

Santamato, Andrea; Facciorusso, Salvatore; Spina, Stefania; Cinone, Nicoletta; Avvantaggiato, Christian; Santoro, Luigi; Ciritella, Chiara; Smania, Nicola; Picelli, Alessandro; Gasperini, Giulio; Molteni, Franco; Baricich, Alessio; Fiore, Pietro

doi:10.23736/s1973-9087.20.06478-3

Cited by 18 publications

(26 citation statements)

References 31 publications

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“…This survey shows how strongly the closure of a botulinum toxin outpatient clinic in Austria and thereby prolonged interinjection intervals affected patients’ symptom reoccurrence and their QoL. Case reports and surveys from Italy, the USA, Germany, and the Philippines have already shown the negative influence of COVID-19-related delays of BoNT-A injections on patients suffering from dystonia, spasticity, or migraine (Dressler and Adib Saberi 2020 ; Ali 2020 ; Ranza et al 2020 ; Erro et al 2021 ; Santamato et al 2021 ; Tarantino et al 2021 ; Samadzadeh et al 2021 ; Pajo et al 2021 ). This is underlined by 75–91% of patients perceiving the security of long-term BoNT-A therapy as very important and 76–98% which felt their patient rights not respected by COVID-19 counter measures (this study, Dressler and Adib Saberi 2020 ; Tarantino et al 2021 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…The study taken into consideration was conducted when the need to contain the spread of the virus and to maintain social distancing in Italy led to the temporary suspension of BoNT-A treatment in the outpatient setting ( 11 ).…”

Section: Case Descriptionmentioning

confidence: 99%

“…A recently published Italian study that relate to the suspension of gold-standard therapies focused on botulinum toxin (BoNT-A) injections for spasticity treatment. That provided some food for thought ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Suspension of Care for Patients With Spasticity During COVID-19 Pandemic: Ethical and Medico-Legal Point of View Starting From an Italian Study

et al. 2021

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The COVID-19 pandemic has revolutionized the habits of entire communities, having even more profound negative effects on assistance for the chronically ill. The sudden demand for extraordinary resources caught all worldwide countries unprepared, highlighting shortages in provision of care services. This applies to all patients, affected by COVID-19 or not, as many need continuing access to chronic diseases treatments. Almost all of the energy available has been directed toward care of COVID-19 patients, and almost nothing has been done to continue therapy for patients with spasticity. This study builds on a recent article and discusses its results as a basis for highlighting the ethical dilemmas and unintended consequences of health systems changing their priorities during the pandemic. The above mentioned study has shown increased patient-perceived spasticity during lockdown (72.2%) with reductions in perceived quality of life (70.9%). Telemedicine tools have proved insufficient, with access by only 7.3% of these patients. Despite the health emergency, it cannot be denied that this situation is a violation of these patients' rights and dignity. The healthcare system will also have to bear increased costs in the future to recover the loss of previous therapies benefits, because of their interruption. The real challenge will be to exploit the critical issues emerged during the pandemic, and to resolve the measures needed to take the care to the patient, and not vice versa. This applies particularly to fragile patients, to respect their dignity and right to care.

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“…This deformity often causes significant problems with dressing and in particular shoe wearing, standing, transfer, and walking. It also has an impact on pain, activities of daily life, caregiver burden and the quality of life [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study

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Facciorusso

Botticelli

et al. 2021

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Spastic equinovarus (SEV) foot deformity is commonly observed in patients with post-stroke spasticity. Tibialis posterior (TP) is a common target for botulinum toxin type-A (BoNT-A) injection, as a first-line treatment in non-fixed SEV deformity. For this deep muscle, ultrasonographic guidance is crucial to achieving maximum accuracy for the BoNT-A injection. In current clinical practice, there are three approaches to target the TP: an anterior, a posteromedial, and a posterior. To date, previous studies have failed to identify the best approach for needle insertion into TP. To explore the ultrasonographic characteristics of these approaches, we investigated affected and unaffected legs of 25 stroke patients with SEV treated with BoNT-A. We evaluated the qualitative (echo intensity) and quantitative (muscle depth, muscle thickness, overlying muscle, subcutaneous tissue, cross-sectional area) ultrasound characteristics of the three approaches for TP injection. In our sample, we observed significant differences among almost all the parameters of the three approaches, except for the safety window. Moreover, our analysis showed significant differences in cross-sectional area between treated and untreated. Advantages and disadvantages of each approach were investigated. Our findings can thus provide a suitable reference for clinical settings, especially for novice operators.

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Discontinuation of botulinum neurotoxin type-A treatment during COVID-19 pandemic: an Italian survey in post stroke and traumatic brain injury patients living with spasticity

Cited by 18 publications

References 31 publications

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

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

Suspension of Care for Patients With Spasticity During COVID-19 Pandemic: Ethical and Medico-Legal Point of View Starting From an Italian Study

Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study

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