Real-world analysis of botulinum toxin (BoNT) injections in post-stroke spasticity: Higher doses of BoNT and longer intervals in the early-start group

Woo, Jean; Mas, Manuel F.; Zhang, Juliana; Wong, Bonny S.; Stampas, Argyrios; Francisco, Gerard E.; Sheng, Li

doi:10.1016/j.jns.2021.117449

Cited by 8 publications

(19 citation statements)

References 26 publications

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“…In a prospective, longitudinal study, Picelli et al (11) reported that early BoNT injections (<3 months) had better and longer lasting effects of spasticity reduction than late BoNT injections (>3 months). Similarly, in our retrospective study (12), we found that stroke survivors who received BoNT injections at an earlier time had much longer lasting effects than those who received injections at a late date. Taken together, these studies have supported the benefits of early spasticity intervention after stroke (5,(13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionsupporting

confidence: 65%

“…The mean time to receive BoNT injections was 18 days in a recent study ( 5 ). About one third of patients who received BoNT injections had first BoNT injections within 3 months ( 12 ). The dose of phenol in this study was 7.4 ml, with a range of 1–20 ml in a procedure.…”

Section: Discussionmentioning

confidence: 99%

“…However, due to the nature of chart review study, it was not possible to assess the efficacy of phenol or BoNT injections with commonly used clinical scales, such as modified Ashworth scale. As used in our recent study, the amount of total BoNT dose is an alternative objective outcome assessment after the intervention ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…In general practice, the absolute number of units was higher in abo-BoNT than in ona- or inco-BoNT to achieve similar clinical outcomes. Although there is no definitive evidence for converting units among BoNTs, we adopted the conversion rate we recently used ( 12 ). The total dose of abo-BoNT was converted to an ona-BoNT equivalent dose in a 3:1 ratio, while a 1:1 ratio was used between ona-BoNT and inco-BoNT.…”

Section: Methodsmentioning

confidence: 99%

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Early Use of Phenol Neurolysis Likely Reduces the Total Amount of Botulinum Toxin in Management of Post-Stroke Spasticity

Li¹,

Woo²,

Mas³

2021

Front. Rehabilit. Sci.

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The main objective was to examine practice patterns of phenol neurolysis for post-stroke spasticity management in the early stage. We performed a chart review of patients who were admitted for inpatient rehabilitation within 6 months after first-ever stroke and received phenol neurolysis within 15 months post-stroke. Out of 2,367 stroke admissions from January 2014 and December 2018, 68 patients met the criteria. 52.9% of these patients received phenol neurolysis within 12 weeks, i.e., early stage. The earliest phenol neurolysis procedure was at 19 days after stroke. On average, patients received first phenol injections at 16.3 weeks after stroke with an average dose of 7.3 ml. Most commonly injected nerves were tibial nerve motor branches (41/68), sciatic nerve motor branches (37/68), lateral pectoral nerve (16/68), medial pectoral nerve (15/68), obturator nerve (15/68) and musculocutaneous nerve (15/68). Among 68 patients, 24 received phenol only; 17 received phenol neurolysis first followed by botulinum toxin (BoNT) injections; 19 received BoNT injections first followed by phenol neurolysis; 8 received both phenol and BoNT injections at the same time. The interval from stroke to first procedure was similar between the Phenol-First group (13.3 weeks) and the BoNT-First group (12.6 weeks). The total amount of BoNT was significantly lower in the Phenol-First group (361.3 units) than in the BoNT-First group (515.8 units) (p = 0.005). The total amount of phenol was not statistically different between the Phenol-First group (5.9 ml) and the BoNT-First group (8.3 ml). The interval between the first procedure and its subsequent procedure was not statistically different between the Phenol-First group (18.3 weeks) and the BoNT-First group (10.7 weeks). These long intervals suggest that the subsequent injection (type and dose) was not planned during the first procedure. The general patterns of target areas were similar between BoNT injections and phenol neurolysis, except that phenol neurolysis rarely targeted the upper extremity distal muscles. No side effects after phenol or BoNT injections in the early stage after stroke were observed in the chart review. In summary, phenol neurolysis was started as early as 19 days after stroke. On average, patients received first phenol about 4 months after stroke with an average of 7.3 ml of phenol. Early use of phenol neurolysis likely decreases the total amount of BoNT for management of post-stroke spasticity without increased side effects.

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Section: Introductionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Early Use of Phenol Neurolysis Likely Reduces the Total Amount of Botulinum Toxin in Management of Post-Stroke Spasticity

Li¹,

Woo²,

Mas³

2021

Front. Rehabilit. Sci.

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“… 45 Our real-world clinical data have also revealed that early BoNT injection leads to a much longer interval to repeat BoNT injection. 46 …”

Section: Discussionmentioning

confidence: 99%

Evidence of treating spasticity before it develops: a systematic review of spasticity outcomes in acute spinal cord injury interventional trials

Stampas

Hook²,

Korupolu

et al. 2022

Ther Adv Neurol Disord

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Introduction: Spasticity is a common consequence of spinal cord injury (SCI), estimated to affect up to 93% of people living with SCI in the community. Problematic spasticity affects around 35% people with SCI spasticity. The early period after injury is believed to be the most opportune time for neural plasticity after SCI. We hypothesize that clinical interventions in the early period could reduce the incidence of spasticity. To address this, we evaluated the spasticity outcomes of clinical trials with interventions early after SCI.Methods: We performed a systematic review of the literature between January 2000 and May 2021 to identify control trials, in humans and animals, that were performed early after SCI that included measures of spasticity in accordance with PRISMA guidelines.Results: Our search yielded 1,463 records of which we reviewed 852 abstracts and included 8 human trial peer-reviewed publications and 9 animal studies. The 9 animal trials largely supported the hypothesis that early intervention can reduce spasticity, including evidence from electrophysiological, behavioral, and histologic measures. Of the 8 human trials, only one study measured spasticity as a primary outcome with a sample size sufficient to test the hypothesis. In this study, neuromodulation of the spinal cord using electric stimulation of the common peroneal nerve reduced spasticity in the lower extremities compared to controls.Conclusion: Given the prevalence of problematic spasticity, there is surprisingly little research being performed in the early period of SCI that includes spasticity measures, and even fewer studies that directly address spasticity. More research on the potential for early interventions to mitigate spasticity is needed.

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Real-world differences in dosing and clinical utilization of OnabotulinumtoxinA and AbobotulinumtoxinA in the treatment of upper limb spasticity

Bohart,

Dashtipour,

Kim

et al. 2024

Toxicon

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Real-world analysis of botulinum toxin (BoNT) injections in post-stroke spasticity: Higher doses of BoNT and longer intervals in the early-start group

Cited by 8 publications

References 26 publications

Early Use of Phenol Neurolysis Likely Reduces the Total Amount of Botulinum Toxin in Management of Post-Stroke Spasticity

Early Use of Phenol Neurolysis Likely Reduces the Total Amount of Botulinum Toxin in Management of Post-Stroke Spasticity

Evidence of treating spasticity before it develops: a systematic review of spasticity outcomes in acute spinal cord injury interventional trials

Real-world differences in dosing and clinical utilization of OnabotulinumtoxinA and AbobotulinumtoxinA in the treatment of upper limb spasticity

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