Clinical eﬃcacy of botulinum toxin type A in patients with traumatic brain injury, spinal cord injury, or multiple sclerosis: An observational longitudinal study

Frontiers in Neurology, 2023 · DOI: 10.3389/fneur.2023.1133390 · Published: April 6, 2023

Simple Explanation

This study investigates the effectiveness of Botulinum toxin type A (BoNT-A) in treating spasticity, pain, and improving quality of life (QoL) in patients with multiple sclerosis (MS), spinal cord injury (SCI), and traumatic brain injury (TBI). These conditions often lead to non-stroke spasticity (NSS), and the research explores how BoNT-A can help manage the symptoms. The study followed 86 patients, evaluating them before BoNT-A injections and then at 1, 3, and 6 months post-injection. The researchers measured spasticity, pain, and QoL using standard scales to determine if the treatment improved these outcomes over time. The results showed that BoNT-A can significantly improve spasticity, reduce pain, and enhance QoL in patients with MS, SCI, and TBI. The duration of these benefits varied depending on the specific condition and the number of areas treated. The study suggests BoNT-A is a valuable tool for managing NSS and can inform the creation of tailored treatment plans.

Study Duration

6 months

Participants

86 patients with multiple sclerosis, spinal cord injury, and traumatic brain injury

Evidence Level

Observational, multicentre, non-interventional, prospective cohort study

Key Findings

1
BoNT-A significantly reduces spasticity and pain, and improves QoL in patients with MS, SCI, and TBI up to 3 months after injection.
2
The duration of BoNT-A's therapeutic effect varies depending on the diagnosis, with SCI patients returning to baseline conditions at T2 (3 months), while MS and TBI patients maintained improvement.
3
Patients treated in three or more sites showed a higher QoL improvement, indicating a greater modifiability of QoL-related variables in patients with worse disability conditions.

Research Summary

This study evaluated the clinical efficacy of BoNT-A in reducing spasticity, pain, and improving QoL in patients with SCI, TBI, and MS. The study design was an observational, multicentre, non-interventional, prospective cohort study. The results showed a significant clinical effect of BoNT-A in reducing spasticity and pain, and improving QoL for up to 3 months after injection. Subgroup analysis revealed that the duration of the pharmacological effect may differ based on the underlying clinical condition. The findings suggest that BoNT-A is an effective treatment for NSS and that follow-up programs should be tailored based on the patient's diagnosis to optimize outcomes. Reinjection after 3 to 6 months may be considered to maintain stable control of spasticity and pain.

Practical Implications

Tailored Treatment Plans

Clinicians should consider tailoring BoNT-A treatment plans based on the patient's underlying condition (MS, SCI, or TBI) to optimize the duration of therapeutic effects.

Multifocal Therapy

Implementing BoNT-A in a context of multifocal therapy may be more impactful for patients with more compromised functional status.

Follow-Up Scheduling

Follow-up visits should be scheduled according to the primary diagnosis to ensure timely re-evaluation and reinjection, particularly in SCI patients who may require earlier intervention.

Study Limitations

1
Relatively small sample size, especially in the context of subgroup analysis.
2
Heterogenous population with varied treatment approaches involving both upper and lower limbs.
3
Lack of diagnosis-specific scales such as AIS, EDSS, and GOS-E, which could have provided more detailed insights.

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