Upper-limb Spasticity Research Articles

Clinical Onset of Action of Incobotulinum Toxin A Preparation.

Many studies in vitro compared the onset of action, maximum efficacy, and duration of botulinum toxin type A (BoNT/A) preparations. In this study, we analyzed the onset of action of BoNT/A preparation free of complexing proteins in patients with upper limb spasticity post stroke up to 30 days after treatment. 75 patients affected by Biceps Brachii spasticity were enrolled. Outcome measures were instrumental muscle tone modification (myometric measurement), improvement of Modified Ashworth Scale (MAS), improvement of elbow's passive extension, and improvement of compound muscle action potential (cMAP) evaluated by electroneurography. We analyzed data at t0 (pre-injection), t1 (1 day after), t2 (7 days after), t3 (14 days after), and t4 (30 days after). All measurements decreased at t2, t3, and t4 with initial improvement at t2 and maximum improvement at t4; no statistical difference at t1 was found. This study demonstrated the onset of Incobotulinumtoxin A efficacy started after 7 days; this rapid action and efficacy of BoNT/A preparation could improve an intensive rehabilitation program after some days post-injection. Early clinical onset of action could be by the absence of complexing proteins in the preparation.

Impact of Repetitive Peripheral Magnetic Stimulation on Post-Stroke Patients with Upper Limb Spasticity - A Randomized Controlled Trial

Impact of Repetitive Peripheral Magnetic Stimulation on Post-Stroke Patients with Upper Limb Spasticity - A Randomized Controlled Trial

Upper Limb Spasticity: The Quality of Online Patient Resources.

The aim of the study is to assess the quality, readability, content, accessibility, and structure of online resources for patients with upper limb spasticity. This was a cross sectional study examined Internet searches across three search engines related to patient resources for upper limb spasticity. Search phrases for either hand or upper limb spasticity were used. The top 20 Websites from each search were evaluated using the four readability metrics and the DISCERN scale for quality assessment. YouTube videos with exact search phrases were evaluated using DISCERN. Descriptive statistical analyses were performed using SPSS software. Thirty-six Websites and 33 videos met the inclusion criteria for this study. The average Flesh-Kincaid Grade Level of the Websites was 11.7 ± 3.1, showing low Website readability. According to this index, only two Websites were written at the suggested sixth-grade level (5.4%). With a maximum score of 75, the mean DISCERN score for both Websites and videos scored in the "good" range (53.5 ± 8 and 50.5 ± 6.6), respectively. Current online resources for upper limb spasticity are good in quality but are written above the health literacy level of American citizens. Organizations should consider reviewing their present materials and developing high-quality patient education materials that are easier to understand.

Use of volar distal radius plate dorsally for wrist arthrodesis in patients with upper limb spasticity: A retrospective review

Standard wrist arthrodesis implants are generally designed for adult joints with arthritis. They are often too big for patients with limb spasticity who generally tend to have osteopenic and smaller bones for their age, resulting in high complication rates. We previously described the novel use of volar distal radius variable-angle locking plate (APTUS® Wrist distal radius system 2.5, Medartis AG, Basel, Switzerland) on the dorsum for wrist arthrodesis in patients with limb spasticity. This study aimed to further establish the use of the implant by reporting the outcomes in cohort A (nondistal radius plate) and cohort B (distal radius plate cohort). Patient-reported outcome measures were used to assess the primary outcome, whereas secondary outcomes included implant-related complications and improvement in wrist position and fusion rates. A total of 17 wrist arthrodesis procedures were performed over a period of 4 years in 15 patients for wrist deformity secondary to limb spasticity. There were no complaints of implant prominence, implant or tendon irritation, metacarpal prominence, or extension requiring further treatment in cohort B. Cohort A had a high implant removal rate that is comparable to the published literature. Both groups reported significant improvement in hygiene and wrist position but neither group had any appreciable gain in function. Volar distal radius variable-angle locking plates appear to be safe and have superior patient acceptability and low complication rates when used dorsally for wrist arthrodesis in patients with upper limb spasticity. Comparable overall satisfaction rates in cohort B were reported in relation to the literature and the cohort A in this study.

Treating Upper Limb Spasticity With OnabotulinumtoxinA: Subgroup Analysis of US Practice Patterns From the ASPIRE Study (P12-8.012)

<h3>Objective:</h3> To examine onabotulinumtoxinA (onabotA) treatment utilization patterns in the United States (US) for pronated forearm and intrinsic plus hand postures in patients with upper limb (UL) spasticity over a 2-year period. <h3>Background:</h3> In 2021, onabotA received approval in US for injection into 8 additional muscles in the treatment of adult UL spasticity including muscles of the elbow and forearm (brachialis, brachioradialis, pronator teres, and pronator quadratus), as well as intrinsic hand muscles (lumbricals and interossei) and thumb muscles (flexor pollicis brevis and opponens pollicis). More information is required to maximize effectiveness in patients with UL spasticity. <h3>Design/Methods:</h3> This post hoc analysis utilized US data from the multicenter, prospective, observational Adult Spasticity International Registry (ASPIRE) study (NCT01930786) which ran from 2013 through 2017. Participants were adult patients who received onabotA (total dose ≤400 U per treatment session) to UL muscles for spasticity. This analysis was centered on 2021 onabotA expanded label and evaluated treatment utilization for pronated forearm and intrinsic plus hand postures in patients with UL spasticity to determine educational opportunities for optimized treatment in the real-world setting. <h3>Results:</h3> Of 316 US patients in ASPIRE treated for UL spasticity, 135/316 (43%) had pronated forearm and 89/316 (28%) had intrinsic plus hand postures. OnabotA (≤400 U) treatment was delivered to select UL muscles of 45 patients consistent with expanded US label. Baseline characteristics of these 45 patients included a mean age (SD) of 51.3 (16.0) years, 23/45(51%) who were onabotA-naive, and 26/45 (58%) were male. New postures treated included intrinsic plus hand (9/45; 20.0%) and pronated forearm(14/45;31.1%). Of the 36 adverse events (AEs) that occurred, 1 was treatment-related (muscular weakness); no treatment-related serious AEs were reported. <h3>Conclusions:</h3> This analysis provides real-world evidence of the opportunity to educate on the treatment of pronated forearm and intrinsic plus hand postures in accordance with the expanded label for onabotA. <b>Disclosure:</b> Gerard Francisco has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz. Gerard Francisco has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Allergan. Gerard Francisco has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Saol. Gerard Francisco has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Gerard Francisco has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ekso. Gerard Francisco has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sword Health. Gerard Francisco has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Journal of ISPRM. The institution of Gerard Francisco has received research support from Allergan. The institution of Gerard Francisco has received research support from Merz. The institution of Gerard Francisco has received research support from Ipsen. The institution of Gerard Francisco has received research support from Revance. Gerard Francisco has a non-compensated relationship as a Director with American Board of PM&amp;R that is relevant to AAN interests or activities. Gerard Francisco has a non-compensated relationship as a Vice-Presdent with International Society of Physical and Rehabilitation Medicine that is relevant to AAN interests or activities. Dr. Feng has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for HuaMed Tech. Dr. Feng has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Precision Neuroscience. Dr. Feng has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Namsa. The institution of Dr. Feng has received research support from NIH. The institution of Dr. Feng has received research support from American heart association . Michael C Munin, 25482 has received personal compensation for serving as an employee of Pacira. Michael C Munin, 25482 has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merz. Dr. Ngo has nothing to disclose. Marc Schwartz has nothing to disclose. Dr. Sadeghi has received personal compensation for serving as an employee of AbbVie. Dr. Sadeghi has stock in Abbvie/Abbott. Dr. Zuzek has received personal compensation for serving as an employee of AbbVie Inc.. Dr. Zuzek has stock in AbbVie Inc.. Dr. Esquenazi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ipsen and Allergan. Dr. Esquenazi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ipsen and Allergan. The institution of Dr. Esquenazi has received research support from Ipsen, Allergan and Merz.

Real-World Clinical Utilization Differences of onabotulinumtoxinA and abobotulinumtoxinA in Upper Limb Spasticity (P12-8.013)

<h3>Objective:</h3> To compare real-world clinical utilization of onabotulinumtoxinA (onabotA) and abobotulinumtoxinA (abobotA) in the treatment of adult upper limb spasticity (ULS). <h3>Background:</h3> 3 botulinum toxin type A (BoNT/A) products are approved by the US Food and Drug Administration (FDA) to treat ULS. Each BoNT/A product is manufactured and tested via proprietary processes, resulting in unique clinical profiles. FDA-mandated boxed warnings state that potency units of one product are not interchangeable and cannot be converted into units of another BoNT/A product. We compared real-world clinical utilization of onabotA and abobotA in the treatment of adult ULS. <h3>Design/Methods:</h3> De-identified medical records were obtained via survey of 101 unique healthcare professionals on patients diagnosed with ULS per International Classification of Diseases, 10th revision, (ICD-10) and treated via botulinum toxin using current procedural terminology (CPT) in the US. 215 patient charts were reviewed: 107 treated with onabotA and 108 with abobotA. Patients received at least 3 treatments of onabotA or abobotA in 1 spastic upper limb prior to March 2020. Number and type of muscles injected were compared between BoNT/A products. <h3>Results:</h3> 75% of patients were classified as having moderate-to-severe ULS by the injector. On average, patients were diagnosed with ULS for &gt;3 years: onabotA 44.2 months (10–200) or abobotA 40.0 months (11–212). A significantly greater average number of muscles were injected with onabotA (4.3; range, 1 to 16), compared with abobotA (3.1; range, 1 to 8), <i>P</i>=0.0001. Significantly more patients received onabotA injections in forearm muscles (87/107, 81.3%) compared with abobotA (70/108, 64.8%), <i>P</i>=0.0064. Similarly, a significant difference was observed in the utilization of onabotA in hand muscles (23/107, 21.5%) compared with abobotA (4/108, 3.7%), <i>P</i>=0.0001. <h3>Conclusions:</h3> These results are consistent with published evidence across other indications, further supporting that each BoNT/A product is unique and not interchangeable as indicated by the FDA. <b>Disclosure:</b> Dr. Nelson has received personal compensation for serving as an employee of Allergan, an AbbVie company. Dr. Nelson has received stock or an ownership interest from Allergan, an AbbVie company. Dr. Zuzek has received personal compensation for serving as an employee of AbbVie Inc.. Dr. Zuzek has stock in AbbVie Inc.. Marc Schwartz has nothing to disclose. Dr. Singh has received personal compensation for serving as an employee of AbbVie. Dr. Singh has stock in AbbVie.

Pooled Safety Analysis of IncobotulinumtoxinA in the Treatment of Neurological Disorders in Adults (P12-11.007)

<h3>Objective:</h3> To examine the pooled incidence of treatment-emergent adverse events (TEAEs) and immunogenicity by indication in sponsored incobotulinumtoxinA (INCO) clinical trials in adults. <h3>Background:</h3> The safety and efficacy of INCO in adult neurological disorders has been investigated in multiple prospective clinical trials, including several not yet published. A comprehensive assessment combining available data would provide additional insights into INCO safety. <h3>Design/Methods:</h3> TEAEs were identified in the integrated clinical database of Merz-sponsored placebo (PBO)-controlled studies in adults with cervical dystonia (CD), blepharospasm, upper limb (UL) and lower limb (LL) spasticity, sialorrhea and essential tremor of the UL. Overall incidences of TEAEs and the categories of serious TEAEs (SAEs), TEAEs leading to discontinuation, fatal TEAEs, TEAEs of special interest (AESIs; indicating possible toxin spread) and treatment-related (TR) events were determined for INCO and PBO after a single injection cycle and for INCO after multiple cycles; the most frequent TEAEs, TR-TEAEs and TR-AESIs after a single cycle of INCO were summarized. Neutralizing antibody (NAb) testing was performed in most studies. <h3>Results:</h3> After a single cycle, the incidences of overall TEAEs were similar between INCO and PBO in all indications, although between-indication differences were observed. Most TEAEs were mild to moderate in intensity, and only one subject experienced a TR-SAE. Few TEAEs led to discontinuation of INCO; there were no fatal TEAEs in subjects receiving INCO. In general, repeated cycles did not increase the incidences of any TEAE category. TR-TEAEs affecting ≥1% of patients were uncommon in patients with spasticity. TR-AESIs across all indications were most commonly muscular weakness and dry mouth. Few subjects developed NAb; the vast majority of those positive at the end of the study were also positive at baseline. <h3>Conclusions:</h3> Results of this pooled analysis support and extend the favorable safety and tolerability profile of INCO for the treatment of adult neurological disorders. <b>Disclosure:</b> Dr. Comella has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acorda Therapeutics. Dr. Comella has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck LTD. Dr. Comella has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Allergan Inc. Dr. Comella has received personal compensation in the range of $0-$499 for serving as a Consultant for Merz. Dr. Comella has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acadia. Dr. Comella has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neurocrine. Dr. Comella has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Revance. Dr. Comella has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sunovion. Dr. Comella has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Aeon. Dr. Comella has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz . Dr. Comella has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ipsen. Dr. Comella has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz Pharmaceutical. Dr. Comella has received publishing royalties from a publication relating to health care. Dr. Comella has received publishing royalties from a publication relating to health care. Michael Hast has received personal compensation for serving as an employee of Merz. Angelika Hanschmann has received personal compensation for serving as an employee of Merz Pharmaceuticals GmbH.

Overview of Cochrane systematic reviews for rehabilitation interventions in individuals with cerebral palsy: A mapping synthesis.

This overview of Cochrane systematic reviews (CSRs) reports on current evidence on the effectiveness of rehabilitation interventions for individuals with cerebral palsy (CP) and the quality of the evidence. Following the inclusion criteria defined by the World Health Organization, all CSRs tagged in the Cochrane Rehabilitation database that were relevant for individuals with CP were included. A mapping synthesis was used to group outcomes and comparisons of included CSRs indicating the effect of rehabilitation interventions and the certainty of evidence. A total of eight CSRs were included in the evidence map. The effect of interventions varied across comparisons and the certainty of evidence was inconsistent, ranging from high to very low.The best evidence was found for botulinum neurotoxin A (BoNT-A) combined with occupational therapy in the management of spasticity. However, the effect of BoNT-A on drooling and salivation remains unclear. A paucity of randomized controlled trials studying treatments for both dystonia and postural deformities was noted. This review emphasizes the need to further investigate the effectiveness and cost-benefit of rehabilitation interventions for individuals with CP.

Research progress in extracorporeal shock wave therapy for upper limb spasticity after stroke.

Spasticity is one of the most common complications after stroke. With the gradual intensification of spasticity, stroke patients will have a series of problems such as joint ankylosis and movement restriction, which affect the daily activities and increase the burden on patients' families, medical staff and society. There are many ways to treat post-stroke spasticity before, including physical therapy and exercise therapy, drug therapy, surgery and so on, but not satisfied because of a few shortcomings. In recent years, many researchers have applied extracorporeal shock wave therapy (ESWT) for the treatment of post-stroke spasm and achieved good clinical effect, because it is non-invasive, safe, easy to operate, low cost and other advantages compared with other treatment methods. This article reviews the research progress and existing problems of ESWT in the treatment of post-stroke spasticity.

The use of IncobotulinumtoxinA in spastic forms of cerebral palsy: a review of randomized clinical trials

Botulinum therapy has been used to treat increased muscle tone and spasticity in cerebral palsy (CP) over almost 30 years. Despite this, every year a large number of published scientific articles present new clinical studies devoted to various aspects of the use of botulinum toxin type A (BTA) products in children. The article discusses in detail the results of three major international randomized clinical trials concerning determination the efficacy and safety of the product Xeomin (IncobotulinumtoxinA) in spastic forms of cerebral palsy. All these studies were performed in accordance with the criteria of evidence-based medicine - randomized, prospective, multicenter, comparative, and longitudinal with a large number of patients, clear inclusion and exclusion criteria. The TIM (Treatment with incobotulinumtoxinA in Movement) study demonstrated the effectiveness of the treatment of spasticity of the lower extremities muscles when using different doses of IncobotulinumtoxinA (8, 6 and 2 units/kg of body weight to correct one pathological pattern) in a double-blind study. The TIMO (Treatment with IncobotulinumtoxinA in Movement Open Label) study showed the efficacy and safety of high doses of IncobotulinumtoxinA (total doses of 16-20 units/kg of body weight) in the treatment of spasticity of the lower and upper extremities with prolonged use. The XARA study (IncobotulinumtoxinA in Arm Treatment in Cerebral Palsy) presented data on the high efficacy of IncobotulinumtoxinA when using a multi-level approach for the treatment of lower and upper limb spasticity in CP children and adolescents, which reflects the real clinical needs of a large number of patients. In each of these studies, the safety of the use of IncobotulinumtoxinA was also evaluated. Good tolerability of therapy was demonstrated (84.1% of patients completed all visits in total according to three studies - TIM, TIMO and XARA) and its safety (the frequency of adverse events associated with therapy was observed in less than 2% of cases). Treatment with IncobotulinumtoxinA was characterized by the lack of an immunologic response - Xeomin as a starting therapy provides a stable effect without fading associated with the development of neutralizing antibodies.

Effect Analysis of Botox Combined with Rehabilitation Training on Upper Limb Spasm after Hemiplegia

To analyze the effect of botox on upper limb spasm after hemiplegia after stroke under the background of rehabilitation training is the main objective of the study. The data was collected from 100 patients with upper limb spasm after hemiplegia after stroke treated in Rehabilitation Medicine Department of Zhejiang Hospital from May 2020 to June 2022. These patients were randomly divided into 50 each and included in the study group and the control group. The study group received botox therapy in the context of rehabilitation training, while the control group only received rehabilitation training. The effects of the two groups were compared after treatment. After treatment by different methods, modified Ashworth scale, Fugl-Meyer assessment, the modified Barthel index, specific quality of life scale scores and total effective rate of the study group were better than those of the control group (p<0.05). Botulinum toxin combined with rehabilitation training has obvious effect on upper limb spasticity of hemiplegia after stroke, which can reduce muscle tension, effectively relieve the degree of upper limb spasticity, improve the upper limb motor function and enhance the ability of living. The use of botulinum toxin in rehabilitation training is worthy of promotion.

Physical Therapy Combined with Transcranial Magnetic Stimulation Therapy: Treatment Practice Considering the Effect of Reducing Upper Limb Spasticity on Gait.

We perform physical therapy combined with repetitive transcranial magnetic stimulation (rTMS) in stroke patients with hemiplegia in the maintenance phase with the intent of improving the support of paralyzed leg. In gait evaluation in patients with hemiplegia, it is important to assess elements related to coordination carefully. rTMS therapy is effective in alleviating the tension of upper limbs. As rTMS helps upper-limb swing to become evident during gait, it makes trunk rotation necessary for left-right coordination appear more easily. As a result, rTMS has potential for improved upper-limb swing or trunk rotation. Post-rTMS therapy may prepare for the environment suitable for hip extending the stance phase of the paralyzed side. In physical therapy, it is advisable to practice standing up, maintaining standing posture or walking by making good use of these effects. We conduct practices in combination with the following: standing up focusing on load evenly distributed on both sides, standing on slant-board training, which enables forward shift of center of mass, walking by fixating upper limbs to the back of the body with the intent of extending the stance phase of the paralyzed side, and increasing trunk rotation. It is also necessary to discuss the combination with injection with botulinum toxin, which suppresses spasticity of ankle plantar flexors with the physician. Gait is associated with a variety of factors and has significant intrapatient and interpatient variations. In this regard, physiotherapists are required to develop a treatment program based on a quantitative evaluation, especially, in patients with hemiplegia.

Recombinant botulinum toxin as a new stage in the development of botulinum toxin therapy. Possibilities and perspectives of use in neurological practice

Currently, eight natural serotypes of botulinum neurotoxin (BNT-A-G, -X) are known. The mechanism of action of all BNT serotypes is presynaptic blockade of SNARE transport proteins (Soluble N-ethylmaleimide-sensitive factor [NSF] Attachment Protein Receptor), as a result of which the release of acetylcholine into the synaptic cleft is disrupted and neuromuscular transmission is blocked. Each botulinum toxin serotype selectively binds to its own presynaptic membrane receptor and causes cleavage of its own SNARE protein. These differences determine the neuronal specificity and activity of botulinum toxins, which leads to their unique pharmacological properties, such as activity, duration of action, and time to onset of action. In the international clinical practice, only two BNT serotypes (A and B) are allowed to be used, however, in recent years, a large number of studies on the efficacy and safety of other BNT serotypes (E, C, F) have been carried out, and technologies for changing their natural properties have been developed. One of the indications for the use of botulinum therapy in neurology is the correction of post-stroke spasticity. Currently, BNT-A is used for this purpose, clinical improvement after its injection occurs after 2 weeks, the therapeutic effect persists for 3 months, and then the symptoms of spasticity increase again, which worsens the patient's quality of life and reduces the possibility of medical rehabilitation. The use of fast-acting recombinant botulinum toxins for this purpose could help overcome this disadvantage of BNT-A therapy. Currently the LANTIMA study, supported by IPSEN company, is going on to evaluate the safety profile and level of efficacy of modified recombinant botulinum toxin type AB in the treatment of upper limb spasticity in adults.

OnabotulinumtoxinA Treatment of Upper Limb Spasticity: Analysis of US Practice Patterns From the ASPIRE Study

<h3>Research Objectives</h3> To examine onabotulinumtoxinA (onabotA) utilization patterns within 8 additional muscle groups consistent with updated US label in patients with upper limb (UL) spasticity from the Adult Spasticity International Registry (ASPIRE) study over a 2-year period1-6. <h3>Design</h3> Multicenter, prospective, observational study (NCT01930786). <h3>Setting</h3> US clinical sites. <h3>Participants</h3> Adult patients who received onabotA to UL muscles for spasticity. <h3>Interventions</h3> Total onabotA dose ≤400 U per treatment session consistent with US label. <h3>Main Outcome Measures</h3> OnabotA treatment utilization. <h3>Results</h3> Of 443 US patients, 336 had UL spasticity, 45 of whom received ≤400 U onabotA injections in selected muscles consistent with the newly approved label. Mean age (SD) was 51.3 (16.0) years, 26 (58%) were male, and 23 (51%) were onabotA-naive. Postures treated included clenched fist (71.1%), flexed wrist (55.6%), flexed elbow (73.3%), thumb in palm (20.0%), intrinsic plus hand (20.0%), and pronated forearm (31.1%). Treated postures presenting in patients who received onabotA injections only in muscles consistent with label before July 2021 included clenched fist (93.8%), flexed wrist (100%), flexed elbow (12.1%), and thumb in palm (33.3%). Treated postures in patients who received onabotA injections in muscles consistent with the expanded label in July 2021 included clenched fist (100%), flexed wrist (100%), flexed elbow (100%), thumb in palm (100%), intrinsic plus hand (100%), and pronated forearm (100%). The majority of patients (80.0%) had >1 abnormal posture. Of 38 adverse events (AEs), 1 treatment-related AE (muscular weakness) and no treatment-related serious AEs were reported. <h3>Conclusions</h3> This ASPIRE post hoc analysis provides real-world evidence of the opportunity to educate on the expanded label for onabotA, highlighting elbow, forearm, and finger postures and the ability to treat, on-label, multiple UL postures more holistically. <h3>Author(s) Disclosures</h3> GEF: Consultant for, research grants from Allergan (an AbbVie company), Ipsen, Merz. WF: Research grants: NIH. MCM: Research support: AbbVie, Merz; Advisory board: Ipsen, Pacira. KN: Nothing to report. M Schwartz: Biostatistical consultant: Allergan (an AbbVie company). M Sadeghi, AZ: Employee: AbbVie. AE: Consultant: Allergan (an AbbVie company), Ipsen, Merz; Research grants: Allergan (an AbbVie company), Ipsen.

Switching Adults With Spasticity From OnabotulinumtoxinA to AbobotulinumtoxinA: Real-World Data Across Three US-Based Centers

<h3>Research Objectives</h3> To illustrate the safe transitioning from onabotulinumtoxinA (onaBoNT-A) to abobotulinumtoxinA (aboBoNT-A) in adults with spasticity. <h3>Design</h3> Retrospective study of patient chart data. <h3>Setting</h3> Three US-based treatment centers. <h3>Participants</h3> Patients aged ≥18 years with upper limb (ULS), lower limb (LLS), or ULS and LLS (ULS+LLS) spasticity. <h3>Interventions</h3> ≥2 onaBoNT-A treatment cycles, followed by ≥3 aboBoNT-A treatment cycles. <h3>Main Outcome Measures</h3> The transition of patients from onaBoNT-A to aboBoNT-A. <h3>Results</h3> A total of 88 patients (mean±SD age 44.9±19.6; 62.5% male) switched from onaBoNT-A to aboBoNT-A; in 84 (95.5%), the switch was due to "medical need/effectiveness not achieved." Spasticity etiologies included stroke (25.0%), traumatic brain injury (13.6%), spinal cord injury (2.3%), cerebral palsy (42.0%), multiple sclerosis (9.1%), and other (8.0%). Fifty-one patients (58.0%) had bilateral spasticity, with 5.0±2.2 muscles injected at each visit over the 5-injection-cycle treatment period. Across the 2 initial cycles prior to the switch, mean doses of onaBoNT-A were 425.0±179.0U, 477.1±132.8U, and 454.2±156.0U for ULS, LLS, and ULS+LLS, respectively; following the switch, mean aboBoNT-A doses across 3 treatment cycles were 1005.1±439.2U, 1006.2±334.2U, and 1203.2±325.7U, respectively. No adverse events (AEs) were reported following conversion. <h3>Conclusions</h3> Patients who switched from onaBoNT-A to aboBoNT-A continued for at least 3 treatment cycles without any reported AEs. Mean doses of both onaBoNT-A and aboBoNT-A were generally aligned with the upper ranges of their respective dosing guidelines. Further randomized crossover studies evaluating the efficacy and safety of onaBoNT-A versus aboBoNT-A are warranted. <h3>Author(s) Disclosures</h3> NW: Employee of Cerner Enviza (Kantar Health); ED: Received consultancy fees and/or research support from Allergan, Ipsen, Solstice, Merz; MP and MT: None; JM, AM, and JB: Employees of Ipsen.

A narrative review of clinical studies on thread embedding acupuncture treatment for spasticity after stroke

Objectives: This study aimed to review clinical studies on thread embedding acupuncture (TEA) for the treatment of patients with post-stroke spasticity (PSS)Methods: Clinical studies related to TEA treatment for PSS were searched for in several electronic databases, including PubMed, Cochrane Library, MEDLINE, OASIS, and CNKI. After the selection/exclusion process, information on study design, disease, experimental/control group, intervention, outcome measurement, between-group differences, and adverse events was extracted.Results: A total of 13 randomized controlled trials were included in this review. The usual frequency of TEA treatment was once every 1-2 weeks, and the treatment most commonly included 4 sessions. In the dorsal area, EX-B2 and the acupoints in governing vessel meridian were commonly used. Acupoints in the meridian of the large intestine were most frequently used in the treatment of upper limb spasticity. Except for HT1, PC6, and PC8, all TEA points for treating PSS of the upper limb were on the Yang meridians. For the lower limb spasticity, the most frequently used acupoints were ST36, GB34, GB30, BL60, and BL57 on Yang meridians, and LR3, SP6, SP9, and SP10 on Yin meridians. TEA treatment showed better effects than conventional treatment for PSS in terms of spasticity, motor dysfunction, and activities of daily livings. Nevertheless, the absence of the follow-up observation, lack of sham TEA treatment, and low quality of the included studies necessitated caution in interpreting the results.Conclusions: The results of this review are expected to provide basic data on the modalities of TEA treatment for PSS and provide insights to facilitate well-designed studies in the future.

Generation of iPSC lines from hereditary spastic paraplegia 56 (SPG56) patients and family members carrying CYP2U1 mutations

Hereditary spastic paraplegia 56 (SPG56) is an extremely rare autosomal recessive disorder caused by mutations in the CYP2U1 gene, involved in fatty acid metabolism. SPG56 causes progressive spasticity in upper and lower limbs, though due to the rarity of this subtype of spastic paraplegia, the molecular causes remain unclear and no treatment or cure exists. Here we describe the generation and validation of induced pluripotent stem cell (iPSC) lines from two unrelated patients with SPG56 and two heterozygous family members. These lines can be used to investigate the mechanisms driving progressive spasticity and evaluate the potential for gene replacement therapies.

Comparison of Ultrasound and Electrical Stimulation Guidance for Onabotulinum Toxin-A Injections: A Randomized Crossover Study.

Botulinum neurotoxin (BoNT) injection is an established therapy for limb spasticity and focal limb dystonia. Comparative benefits of injection guidance procedures have not been rigorously studied. We compared 2 targeting techniques for onabotulinumtoxin-A (onabotA) injection for the treatment of focal hand dystonia and upper limb spasticity: electrophysiologic guidance using electrical stimulation (E-stim) and ultrasound (US). This was a 2-center, randomized, crossover, assessor-blinded trial. Participants with focal hand dystonia or upper limb spasticity, on stable onabotA therapy for at least 2 previous injection cycles, were randomly assigned to either E-stim or US with crossover at 3 months. The primary outcome was improvement in dystonia or spasticity severity on a visual analog scale (VAS; 0-100) measured 1 month after each injection. The secondary outcome was participant discomfort assessed on a VAS. Repeated-measures analysis of covariance was used with linear mixed-model covariate selection. A total of 19 participants (13 men) completed the study, 10 with upper limb spasticity and 9 with dystonia. Benefit was equivalent between the 2 techniques (VAS least-square mean [LSmean] 51.5 mm with US and 53.1 with E-stim). E-stim was perceived as more uncomfortable by participants (VAS LSmean 34.5 vs. 19.9 for E-stim and US, respectively). Procedure duration was similar with the 2 procedures. There were no serious adverse events related to either approach. US and E-Stim localization guidance techniques provide equivalent efficacy in onabotA injections for spasticity and dystonia. US guidance injections are more comfortable for participants. Both techniques are effective guidance methods, with US potentially preferable based on participant comfort.

TU-206. Application of neuroelectrophysiology in the assessment of upper limb spasticity after stroke

TU-206. Application of neuroelectrophysiology in the assessment of upper limb spasticity after stroke

Application of 3D motion analysis to quantify a clinical test method assessing upper limb spasticity

Application of 3D motion analysis to quantify a clinical test method assessing upper limb spasticity