Botulinum Toxin Treatment For Spasticity Research Articles

Descriptive analysis of the annual cost of treating spasticity with different types of botulinum toxin A

IntroductionBotulinum toxin A is the first-line treatment for localised spasticity. However, the economic impact of this treatment is not fully known. This study aimed to describe the real costs of botulinum toxin A for the treatment of adult patients with spasticity at a spasticity clinic pertaining to a rehabilitation service, over a period of one year. MethodsWe retrospectively reviewed all medical procedures carried out during the year 2017. We collected data on the type of toxin used (incobotulinumtoxin A, onabotulinumtoxin A, or Abobotulinumtoxin A), the number of units injected, the anatomical region, and the time elapsed between infiltrations. The costs of medication and indirect costs, such as staff and consumables, were also calculated. ResultsThis is the first study to describe the real costs of botulinum toxin treatment of spasticity in adult patients in Spain. In 2017, 510 infiltration procedures were performed in 164 patients. The total cost of treating spasticity in our service was 116 789.70. The mean annual cost per patient was 603.64 for onabotulinumtoxin A, 642.69 for abobotulinumtoxin A, and 707.59 for incobotulinumtoxin A. ConclusionsOur economic study of real clinical practice is consistent with the theoretical models published in the literature. The different characteristics of each toxin and the inability to establish an equivalence between the units of each drug prevents us from directly comparing these costs.

A reliable source of information on botulinum toxin injection used in the treatment of spasticity: YouTube

Aim: The aim of the study is to assess the quality and reliability of YouTube videos on botulinum toxin injection for the treatment of spasticity.
 Material and Method: In this cross-sectional study, a search of YouTube videos was made on 15 September 2020, using the keywords "botulinum toxin and spasticity", "botulinum toxin treatment for spasticity", “spasticity management with botulinum toxin" "treating spasticity with botox". Two experienced reviewers on botulinum toxin injection on spasticity reviewed the first 200 videos. The quality of the videos was evaluated according to the Global Quality Scale (GQS) and three groups were formed: high quality, intermediate quality and low quality. The DISCERN tool was used to evaluate the reliability of the videos.
 Results: Of the 77 videos analyzed according to GQS, 36 (46.8%) were high quality, 31 (40.2%) were intermediate quality and 10 (13.0%) were low quality. Most of the videos (44.15%, n=34) uploaded by health professionals (physiatrist, orthopedist etc.) and the majority of the health professional groups had produced high quality videos (67.64%). When the parameters of the videos were compared according to quality levels, no significant differences were found in the number of view, comment, likes, dislikes, video length, days since upload (p>0.05). Significant differences were only found between the groups in respect of the DISCERN scores (p

Impact of Botulinum Toxin Consultation Shutdown Due to the Covid-19 Pandemic on Spasticity Treatment: A Review of the Literature

Introduction: The COVID-19 pandemic has imposed an additional pressure on health systems worldwide, creating an increased challenge to chronic patient management due to consultation shutdown. Spastic patients were especially vulnerable to inadequate care. This review aims to describe the impact of botulinum toxin (BT) consultation interruption due to the COVID-19 pandemic on spasticity treatment. Methods: A literature search was conducted in the database of Medline, PubMed, Embase, Google Scholar and Scopus. Keywords for the search included “COVID-19” AND “Botulinum Toxin” AND “Spasticity”. Results: A total of 6 studies reporting the impact of BT consultation suspension on spasticity due to the COVID-19 pandemic met inclusion criteria. All studies were observational and included a small sample. Consultation interruption was variable between studies and ranged from 36-75 days, originating a mean treatment delay of 23-129 days due to re-scheduling difficulties. The majority (72-93%) of patients in all studies perceived worsening of spasticity with BT consultation suspension. Effects seem to be worse with longer treatment delays and concerning the mobility and passive function treatment objectives. Some studies reported a worse quality of life in patients with BT treatment delay whilst others did not find this association. Discussion: Although a year has passed since the start of the COVID-19 pandemic, there is a scarcity of studies reporting the impact of BT consultation interruption on the treatment of spastic patients. An increased inter-treatment delay originates a reduction in the effectiveness at the end of the treatment cycle due BT washout. On average, a 1% worsening of symptoms occurs with one day of delay. Thus, a small delay of a few weeks can lead to worsening of symptoms which may take several treatment cycles to return to previous stable benefit level. The impact of BT consultation suspension on quality of life is controversial and further studies are necessary to clarify this question. Conclusions: The COVID-19 pandemic has had a major negative impact on the BT treatment of spasticity. Thus, consultation shutdown severely affected these patients and needs to be avoided.

Inertial sensor based quantitative assessment of upper limb range of motion and functionality before and after botulinum toxin: a pilot study

Botulinum toxin (BTX) treatment of upper limb is considered effective for upper limb spasticity following stroke and brain injury. Traditional method - Modified Ashworth Scale (MAS) is widely used for assessment of spasticity, however, it suffers from limitations including the lack of objective outcome measures and ignorance of the active movements. This pilot study is to develop a quantitative assessment utilizing inertial sensors tool for upper limb movement measurement and to investigate an objective measure of upper limb function for neurological patients before and after BTX treatment of spasticity. The system we proposed provides kinematic measurements of upper limb segment and joint motion data. In this study, four stroke patients were assessed by an inertial sensing system immediately before and one week after BTX injection. In addition, patients were assessed using clinical assessment scales e.g. MAS, Disability Assessment Scale (DAS) and Motor Assessment Scale. The results showed that elbow Active Range of Motion (AROM) increased by 19 degrees on average and MAS and Motor Assessment Scale scores did not show significant change. The changes of the kinematic measures for patients 1-3 e.g. AROM, Rate of change of elbow joint angle, NJS, MUN and S-ratio all show that the inertial system is able to identify improvement in performance. This inertial sensing system provides additional and novel dynamic motion data for a sensitive and quantitative assessment of response to treatment and the efficacy of post-injection physiotherapy.

Correction to: Budget impact of botulinum toxin treatment for spasticity after stroke – a German perspective

Studies indicate an undersupply (Dressler et al. 2015; Jost et al. 2015; Kerkemeyer et al. 2017; Potempa et al. 2019; Wissel et al. 2016).

Análisis descriptivo de coste de tratamiento de la espasticidad con diferentes tipos de toxina botulínica A, a lo largo de un año

IntroductionBotulinum toxin A is the first-line treatment for localised spasticity. However, the economic impact of this treatment is not fully known.This study aimed to describe the real costs of botulinum toxin A for the treatment of adult patients with spasticity at a spasticity clinic pertaining to a rehabilitation service, over a period of one year. MethodsWe retrospectively reviewed all medical procedures carried out during the year 2017. We collected data on the type of toxin used (incobotulinumtoxin A, onabotulinumtoxin A, or AAbobotulinumtoxin A), the number of units injected, the anatomical region, and the time elapsed between infiltrations. The costs of medication and indirect costs, such as staff and consumables, were also calculated. ResultsThis is the first study to describe the real costs of botulinum toxin treatment of spasticity in adult patients in Spain. In 2017, 510 infiltration procedures were performed in 164 patients. The total cost of treating spasticity in our service was €116 789.70. The mean annual cost per patient was €603.64 for onabotulinumtoxin A, €642.69 for abobotulinumtoxin A, and €707.59 for incobotulinumtoxin A. ConclusionsOur economic study of real clinical practice is consistent with the theoretical models published in the literature. The different characteristics of each toxin and the inability to establish an equivalence between the units of each drug prevents us from directly comparing these costs.

Budget impact of botulinum toxin treatment for spasticity after stroke \u2014 a German perspective

AimBotulinum toxin agents can improve the quality of life of patients with post-stroke upper limb spasticity (ULS) and are recommended by international and German guidelines. However, health-services research indicates an underuse of botulinum toxin agents in this patient group. The study aims to clarify the budget impact of treatment with botulinum toxin agents according to the guidelines for all eligible patients with ULS in Germany compared to usual care.MethodsThe budgetary impact for the statutory health insurance system was estimated by calculating a Markov cohort model with a timeframe of 5 years comparing three treatment options. Four health states were included. The base-case analysis compares standard doses of two botulinum toxin agents to usual care. The model accounts for direct medical costs. Sensitivity analyses vary doses of botulinum toxin agents and prevalence of spasticity after stroke.ResultsIn the base case, both botulinum toxin agents lead to increased costs compared to usual care. Treatment with Dysport® (cumulative costs for the 5-year period: €280,321,317) is less expensive than the treatment with Xeomin® (€377,511,529). Cumulative costs over 5 years in usual care are €61,306,062.ConclusionThe botulinum toxin therapy is associated with additional costs, but an increased use of botulinum toxin would be consistent with guideline-based therapy. In particular, it has to be considered that spasticity as a chronic condition is accompanied by a relevant loss of quality of life. Thus, considering only the therapy costs may not be sufficient for making final therapeutic decisions.

Botulinum toxin treatment of spasticity targeted to muscle endplates: an international, randomised, evaluator-blinded study comparing two different botulinum toxin injection strategies for the treatment of upper limb spasticity

ObjectivesThe therapeutic effects of botulinum neurotoxin (BoNT) are well documented in upper limb spasticity. However, several factors may influence treatment efficacy, including targeting of neuromuscular junctions (NMJs). We examined whether...

Immunogenicity induced by botulinum toxin injections for limb spasticity: A systematic review.

The imputability of neutralizing antibodies (NABs) in secondary non-response (SnR) to botulinum toxin (BoNT) injections for limb spasticity is still debated. This systematic literature review aimed to determine the prevalence of NABs after BoNT injections for limb spasticity and analyze their determinants and their causal role in SnR. We searched MEDLINE via PubMed, Cochrane and Embase databases for articles published during 1990-2018. Two independent reviewers extracted the data and assessed the quality of studies with a specific scale (according to PRISMA and STROBE guidelines). Because the techniques used to detect NABs did not influence the results, we calculated the global (all studies) sensitivity and specificity of NAB positivity to reveal SnR. We included 14 articles published from 2002 to 2018 (including an epublication) describing 5 randomized controlled trials and 5 interventional and 4 observational studies. The quality was satisfactory (mean score 18/28 arbitrary units). NAB detection was the primary criterion in 5 studies and a secondary criterion in 9. In total, 1234 serum samples for 1234 participants (91% with stroke) were tested after injection. NAB prevalence was about 1%, with no significant difference among formulations. NAB positivity seemed favoured by long-duration therapy with high doses and a short interval between injections. The identification of non-response by NAB positivity had poor global sensitivity (56%) but very high specificity (99.6%). No consensual criteria were used to diagnose non-response to BoNT injection. NAB prevalence is much lower after BoNT treatment for limb spasticity than cervical dystonia. Consensual criteria must be defined to diagnose non-response to BoNT injection. Because immunogenicity is not the most common cause of non-response to BoNT injection, NABs should be sought in individuals with SnR with no other cause explaining the treatment inefficacy. A test with 100% specificity is recommended. In cases for which immunogenicity is the most likely cause of non-response to BoNT injections, some biological arguments suggest trying another BoNT, but no clinical evidence supports this strategy.

Patterns of botulinum toxin treatment for spasticity and bleeding complications in patients with thrombotic risk

The purpose of this study was to assess the prevalence of compartment syndrome or major bleeding episodes and compare compartment syndrome, patient and intervention characteristics in 110 patients with stroke (treated with Warfarin, new oral anticoagulants, antiplatelet, or no anticoagulants) treated for spasticity in deep leg compartment muscles with botulinum toxin injections [onabotulinumtoxinA (n = 77); incobotulinumtoxinA (n = 33)]. We reviewed 674 injection cycles (range 1–25 cycles per patient) and found no cases of compartment syndrome in any patient groups.

Botulinum toxin treatment for spasticity: Clinical experience with changing from abobotulinumtoxina (DYSPORT) to incobotulinumtoxina (XEOMIN)

botulinum toxin treatment for spasticity: Clinical experience with changing from abobotulinumtoxina (DYSPORT) to incobotulinumtoxina (XEOMIN)

Botulinum Toxin Treatment of Spasticity in Adults and Children.

Spasticity is a frequent symptom in stroke, multiple sclerosis, cerebral or spinal trauma, and cerebral palsy that affects and disables a large number of adults and children. In this review, we discuss the pathophysiology and nonpharmacologic and pharmacologic treatments of spasticity with emphasis on the role of botulinum neurotoxins (BoNTs). The world literature is reviewed on double-blind and placebo-controlled clinical trials reporting safety and efficacy of BoNT treatment in adult spasticity and spasticity of children with cerebral palsy. The evidence for efficacy is presented from recommendations of the Assessment and Therapeutics subcommittee of the American Academy of Neurology. A technical section describes the techniques and recommended doses of BoNTs in spasticity.

High dose Botulinumtoxin treatment of spasticity after stroke

High dose Botulinumtoxin treatment of spasticity after stroke

Patients’ baseline characteristics in SPACE, an international, non-interventional study of botulinum toxin treatment for spasticity

Patients’ baseline characteristics in SPACE, an international, non-interventional study of botulinum toxin treatment for spasticity

SPACE, interim analyses of an international, non-interventional study of botulinum toxin treatment for spasticity

SPACE, interim analyses of an international, non-interventional study of botulinum toxin treatment for spasticity

Improvements in healthcare and cost benefits associated with botulinum toxin treatment of spasticity and muscle overactivity

Spasticity is a widespread, disabling form of muscle overactivity affecting patients with central nervous system damage resulting in upper motor neurone syndrome. There is a range of effective therapies for the treatment of spasticity (e.g. physical, anaesthetic, chemodenervation and neurolytic injections, systemic medication and surgery), but all therapies must be based on an individualized, multidisciplinary programme targeted to achieve patient goals. Appropriate therapy should be based on the extent and severity of spasticity, but spasticity and its consequences, regardless of presentation or cause, are commonly treated with systemic agents. This may be ill-advised as systemic treatment is associated with many undesirable effects. In particular, elderly patients with post-stroke spasticity are at risk from the central adverse effects of systemic medication (e.g. sedation and gait disturbance), which make them more susceptible to falling, with an associated increased risk of fracture. The rising costs of fracture care and its sequelae are fast becoming an international problem contributing to high healthcare expenditure. Botulinum toxin type-A (BoNT-A) treatment is highly effective for some of the more common forms of spasticity and muscle overactivity, and has a favourable profile when compared with systemic agents and other focal treatments. Therefore, the clinical benefits of BoNT-A treatment outweigh the apparent high costs of this intervention, showing it to be a cost-effective treatment.

Botulinum toxin treatment of spasticity: A clinical and neurophysiological study

Botulinum toxin treatment of spasticity: A clinical and neurophysiological study