Botulinum toxin treatment of painful tonic spasms in multiple sclerosis.

Abstract

Painful tonic spasms (PTS) involving upper or lower limbs can occur in patients with multiple sclerosis (MS). They may be disabling and difficult to manage.1-3⇓⇓ PTS have been attributed to ephaptic spreading of abnormal transient electric discharges throughout demyelinated axons, in the spinal cord, brainstem, or hemispheric white matter.4,5⇓ PTS are usually treated with antiepileptic medications such as carbamazepine, phenytoin, gabapentin, or benzodiazepines.1-3⇓⇓ These drugs, which require daily administration, may not provide adequate relief or may cause adverse effects.1 Because botulinum neurotoxin type A (BoNT/A) has proven effective in the treatment of hypertonic muscular activity of varying etiologies,6,7⇓ we tested it on patients with MS and PTS. We treated five patients with MS (three men, two women; age range 25 to 52 years), including three with a relapsing-remitting and two with a secondary progressive form. Clinical data are reported in table 1A. View this table: Table 1A. Clinical data of the five patients with multiple sclerosis …