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Filippetti M, Tamburin S, Di Censo R, Adamo M, Manera E, Ingrà J, Mantovani E, Facciorusso S, Battaglia M, Baricich A, Santamato A, Smania N, Picelli A. Role of Diagnostic Nerve Blocks in the Goal-Oriented Treatment of Spasticity with Botulinum Toxin Type A: A Case-Control Study. Toxins (Basel) 2024; 16:258. [PMID: 38922151 PMCID: PMC11209555 DOI: 10.3390/toxins16060258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
The goal-setting process is pivotal in managing patients with disabling spasticity. This case-control study assessed the role of diagnostic nerve blocks in guiding the goal-setting process within goal-targeted treatment of spasticity with botulinum neurotoxin-A. In this case-control study, patients with disabling spasticity underwent either a goal-setting process based on the patient's needs and clinical evaluation (control group) or additional diagnostic nerve block procedures (case group). All enrolled patients underwent a focal treatment with botulinum neurotoxin-A injection and a 1-month follow-up evaluation during which goal achievement was quantified using the goal attainment scaling-light score system. Data showed a higher goal achievement rate in the case group (70%) than in the control group (40%). In conclusion, diagnostic nerve blocks may help guide the goal-setting process within goal-targeted treatment of spasticity with botulinum neurotoxin-A towards more realistic and achievable goals, thereby improving the outcomes of botulinum neurotoxin-A injection. Future studies should better explore the role of diagnostic nerve blocks to further personalize botulinum neurotoxin-A according to individual patients' preferences and requirements.
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Affiliation(s)
- Mirko Filippetti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Rita Di Censo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Martina Adamo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Elisa Manera
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Jessica Ingrà
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Salvatore Facciorusso
- Spasticity and Movement Disorders ‘ReSTaRt’ Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
| | - Marco Battaglia
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (M.B.); (A.B.)
| | - Alessio Baricich
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (M.B.); (A.B.)
| | - Andrea Santamato
- Spasticity and Movement Disorders ‘ReSTaRt’ Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, ON K7K 1Z6, Canada
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Haupts MR, Essner U, Mäurer M. Patient-reported benefits from nabiximols treatment in multiple sclerosis-related spasticity exceed conventional measures. Neurodegener Dis Manag 2024; 14:11-20. [PMID: 38318862 PMCID: PMC11238742 DOI: 10.2217/nmt-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
Aim: This prospective, multicenter, open-label, noninterventional 12-week study investigated the effectiveness and tolerability of add-on nabiximols oromucosal spray (Sativex®) in the real-world setting in Germany. Patients & methods: The main analysis set comprised 51 adult patients (49 nabiximols responders) with multiple sclerosis (MS) spasticity. Results: The mean overall goal attainment scale score (primary outcome measure) increased by 46% from baseline to week 12 (35.2 vs 51.4; p < 0.001). Mean gait speed was improved by 23% at 4 and 12 weeks. Clinically meaningful improvements in mean 0-10 numerical rating scale scores for spasticity, pain, sleep quality and urinary bladder dysfunction were recorded at 4 and 12 weeks. Conclusion: Nabiximols is a useful therapeutic option for patients with MS spasticity.
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Affiliation(s)
- Michael R Haupts
- Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, 40225, Germany
| | - Ute Essner
- O. Meany Consultancy GmbH, Hamburg, 22339, Germany
| | - Mathias Mäurer
- Klinik für Neurologie, Juliusspital Würzburg Klinikum Würzburg Mitte gGmbH, Würzburg, 97070, Germany
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Gupta AD, Baguley I, Estell J, Geffon S, Goh K, Rawicki B, de Graaf S, Olver J. Statement of the Rehabilitation Medicine Society of Australia and New Zealand for the therapeutic use of botulinum toxin A in spasticity management. Intern Med J 2024; 54:178-182. [PMID: 38267377 DOI: 10.1111/imj.16300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024]
Abstract
The Rehabilitation Medicine Society of Australia and New Zealand advocates the safe, effective and evidence-based use of botulinum toxin type A for spasticity management. The process requires appropriate training, alongside considerable knowledge and skills, to maximise efficacy. The processes before and after injection contribute to effectiveness. The gold standard of managing spasticity is for assessment by a multidisciplinary specialist team, deriving patient-centric goals, and designing an injection protocol to match these goals. The patient and/or carers are considered part of the decision-making team. Postinjection therapy and measurement of goal achievement are highly recommended as part of the wider holistic approach to management. The Society believes treatment failures can be minimised by following clear clinical guidelines.
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Affiliation(s)
- Anupam Datta Gupta
- Central Adelaide Local Health Network, Queen Elizabeth Hospital (SA), University of Adelaide, Adelaide, South Australia, Australia
| | - Ian Baguley
- Brain Injury Rehabilitation Service, Westmead Rehabilitation Hospital, Sydney, New South Wales, Australia
| | - John Estell
- Department of Rehabilitation Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Saul Geffon
- Queensland Rehabilitation Specialists, Brisbane, Queensland, Australia
| | - Kong Goh
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Barry Rawicki
- Masada Hospital Consulting Rooms, Melbourne, Victoria, Australia
| | - Stephen de Graaf
- Epworth Rehabilitation Camberwell, Melbourne, Victoria, Australia
| | - John Olver
- Epworth Rehabilitation Clinical Institute, Melbourne, Victoria, Australia
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