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Safety and efficacy of botulinum toxin A for the treatment of spasticity in amyotrophic lateral sclerosis: results of a pilot study.
J Neurol. 2016 Oct; 263(10):1954-60.JN

Abstract

Spasticity can be a very disabling problem in some amyotrophic lateral sclerosis (ALS) phenotypes, such as upper motor neuron-dominant ALS (UMN-D ALS) and primary lateral sclerosis (PLS). Our aim is to describe the safety and efficacy of botulinum toxin A (BoTox-A) for improving gait in those ALS phenotypes. UMN-D ALS and PLS outpatients experiencing gait disturbances, secondary to moderate-to-severe spasticity despite optimized oral medication, were offered BoTox-A treatment. Stretching exercises were indicated to complement BoTox-A effect, and ankle-foot orthotics were prescribed when appropriate. Tolerance (muscle strength, disease progression rate) and efficacy (10-m walk test) were measured at baseline and after treatment. Eight out of 122 ALS outpatients were offered BoTox-A treatment. One declined and the other seven were administered BoTox-A in the lower limbs, every 5-8 months. All of them experienced improvement in the clinical outcome and all but one referred subjective improvement. Moreover, after a median follow-up of 16 months and three injections, BoTox-A effect was maintained with no adverse events. This study provides class IV evidence that BoTox-A is safe , and could be beneficial in the short term and long term in a subset of ALS patients with moderate-to-severe spasticity.

Authors+Show Affiliations

Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain. juan.vazquez.neuro@gmail.com. ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain. juan.vazquez.neuro@gmail.com. Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain. juan.vazquez.neuro@gmail.com.ALS Unit, Department of Rehabilitation, Hospital Universitario y Politécnico La Fe, Valencia, Spain.ALS Unit, Department of Rehabilitation, Hospital Universitario y Politécnico La Fe, Valencia, Spain.ALS Unit, Department of Rehabilitation, Hospital Universitario y Politécnico La Fe, Valencia, Spain.ALS Unit, Department of Rehabilitation, Hospital Universitario y Politécnico La Fe, Valencia, Spain.Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain. ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain. Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain. Department of Medicine, University of Valencia, Valencia, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27383643

Citation

Vázquez-Costa, Juan F., et al. "Safety and Efficacy of Botulinum Toxin a for the Treatment of Spasticity in Amyotrophic Lateral Sclerosis: Results of a Pilot Study." Journal of Neurology, vol. 263, no. 10, 2016, pp. 1954-60.
Vázquez-Costa JF, Máñez I, Alabajos A, et al. Safety and efficacy of botulinum toxin A for the treatment of spasticity in amyotrophic lateral sclerosis: results of a pilot study. J Neurol. 2016;263(10):1954-60.
Vázquez-Costa, J. F., Máñez, I., Alabajos, A., Guevara Salazar, M., Roda, C., & Sevilla, T. (2016). Safety and efficacy of botulinum toxin A for the treatment of spasticity in amyotrophic lateral sclerosis: results of a pilot study. Journal of Neurology, 263(10), 1954-60. https://doi.org/10.1007/s00415-016-8223-z
Vázquez-Costa JF, et al. Safety and Efficacy of Botulinum Toxin a for the Treatment of Spasticity in Amyotrophic Lateral Sclerosis: Results of a Pilot Study. J Neurol. 2016;263(10):1954-60. PubMed PMID: 27383643.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and efficacy of botulinum toxin A for the treatment of spasticity in amyotrophic lateral sclerosis: results of a pilot study. AU - Vázquez-Costa,Juan F, AU - Máñez,Inmaculada, AU - Alabajos,Ana, AU - Guevara Salazar,Maricruz, AU - Roda,Cristina, AU - Sevilla,Teresa, Y1 - 2016/07/06/ PY - 2016/04/18/received PY - 2016/06/29/accepted PY - 2016/06/28/revised PY - 2016/7/8/entrez PY - 2016/7/8/pubmed PY - 2017/4/8/medline KW - Amyotrophic lateral sclerosis KW - Botulinum toxin KW - Primary lateral sclerosis KW - Spasticity SP - 1954 EP - 60 JF - Journal of neurology JO - J. Neurol. VL - 263 IS - 10 N2 - Spasticity can be a very disabling problem in some amyotrophic lateral sclerosis (ALS) phenotypes, such as upper motor neuron-dominant ALS (UMN-D ALS) and primary lateral sclerosis (PLS). Our aim is to describe the safety and efficacy of botulinum toxin A (BoTox-A) for improving gait in those ALS phenotypes. UMN-D ALS and PLS outpatients experiencing gait disturbances, secondary to moderate-to-severe spasticity despite optimized oral medication, were offered BoTox-A treatment. Stretching exercises were indicated to complement BoTox-A effect, and ankle-foot orthotics were prescribed when appropriate. Tolerance (muscle strength, disease progression rate) and efficacy (10-m walk test) were measured at baseline and after treatment. Eight out of 122 ALS outpatients were offered BoTox-A treatment. One declined and the other seven were administered BoTox-A in the lower limbs, every 5-8 months. All of them experienced improvement in the clinical outcome and all but one referred subjective improvement. Moreover, after a median follow-up of 16 months and three injections, BoTox-A effect was maintained with no adverse events. This study provides class IV evidence that BoTox-A is safe , and could be beneficial in the short term and long term in a subset of ALS patients with moderate-to-severe spasticity. SN - 1432-1459 UR - https://www.unboundmedicine.com/medline/citation/27383643/Safety_and_efficacy_of_botulinum_toxin_A_for_the_treatment_of_spasticity_in_amyotrophic_lateral_sclerosis:_results_of_a_pilot_study_ L2 - https://dx.doi.org/10.1007/s00415-016-8223-z DB - PRIME DP - Unbound Medicine ER -