Botulinum toxin treatment for multiple sclerosis and post-stroke spasticity in clinical practice: differences in...

Area of Science:

• Neurology
• Rehabilitation Medicine

Background:

• Botulinum toxin type A (BoNT-A) is a recognized treatment for spasticity in multiple sclerosis (MS) and post-stroke spasticity (PSS).
• Understanding differences in BoNT-A application between MS and PSS is crucial for optimizing treatment strategies.

Purpose of the Study:

• To compare BoNT-A injection patterns and dosages between patients with MS and PSS.
• To analyze differences in muscle targeting and dose administration for spasticity management in these two conditions.

Main Methods:

• Retrospective analysis of 33 patients with MS and 55 patients with PSS treated with BoNT-A.
• Data collected included demographics, BoNT-A dosages, limb-specific dosing, and injected muscle patterns.
• Comparison of treatment parameters and patient-reported benefit between the MS and PSS groups.

Main Results:

• Patients with MS received lower total BoNT-A doses, with more frequent lower limb injections (adductors, rectus femoris).
• Patients with PSS more commonly received treatment in distal upper-limb muscles (e.g., tibialis posterior in lower limbs).
• Higher Expanded Disability Status Scale (EDSS) scores in MS correlated with higher BoNT-A dosages.

Conclusions:

• MS-related spasticity predominantly affects lower limbs, requiring lower BoNT-A doses than PSS.
• PSS spasticity is often more distal and upper-limb predominant, influencing BoNT-A treatment patterns.
• Differences in spasticity distribution and potential need to preserve motor function may explain dosage variations; treatment efficacy appears comparable.