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OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity.

Abstract

Spasticity is a muscle tone disorder associated with different neurological conditions. Spasticity could be associated with pain, high disability, poor functional recovery, and reduced quality of life. Botulinum neurotoxin type A (BoNT-A) is considered a first-line treatment for spasticity and, more recently, it also represents a therapeutic option for various chronic pain conditions. In this open label study, we aim to evaluate the effect of the BoNT-A on the spinal nociception in patients affected by spasticity of the lower limbs with associated pain with predominantly neuropathic features. Ten patients with stroke, 10 with multiple sclerosis and 5 with spinal cord injury were enrolled in the study. They were tested with clinical scales (neuropathic pain scale inventory (NPSI), numerical rating scale (NRS), modified Ashworth scale (MAS) and with the nociceptive withdrawal reflex at lower limbs to explore the spinal temporal summation threshold at baseline and 30 day after BoNT-A injection. OnabotulinumtoxinA (50 to 200 units per site) was injected in the lower limb muscles according to the distribution of spasticity. No significant differences were found at baseline for neurophysiological features across groups. After the BoNT-A injection, we recorded a significant reduction in MAS and NRS scores. Regarding the neurophysiological parameters, we described a significant increase in the temporal summation threshold after the BoNT-A injection. Our data supports the hypothesis that peripherally injected OnabotulinumtoxinA modulates the excitability of spinal cord nociceptive pathways. This activity may take place irrespective of the effect of the drug on spasticity.

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  • Authors+Show Affiliations

    ,

    Neurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy. roberto.deicco@mondino.it. Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy. roberto.deicco@mondino.it.

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    IRCCS Neuromed, 86077 Pozzilli, IS, Italy. arm.perrotta@gmail.com.

    ,

    Neurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy. eliana.berra@mondino.it.

    ,

    Neurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy. marta.allena@mondino.it.

    ,

    Department of Neurophysiopathology, IRCCS Mondino Foundation, 27100 Pavia, Italy. enrico.alfonsi@mondino.it.

    ,

    Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy. stefano.tamburin@univr.it.

    ,

    Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00100 Rome, Italy. mariano.serrao@uniroma1.it.

    ,

    Neurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy. giorgio.sandrini@unipv.it. Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy. giorgio.sandrini@unipv.it.

    Neurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy. cristina.tassorelli@unipv.it. Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy. cristina.tassorelli@unipv.it.

    Source

    Toxins 11:6 2019 Jun 20 pg

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31226803

    Citation

    De Icco, Roberto, et al. "OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients With Lower Limb Spasticity." Toxins, vol. 11, no. 6, 2019.
    De Icco R, Perrotta A, Berra E, et al. OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity. Toxins (Basel). 2019;11(6).
    De Icco, R., Perrotta, A., Berra, E., Allena, M., Alfonsi, E., Tamburin, S., ... Tassorelli, C. (2019). OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity. Toxins, 11(6), doi:10.3390/toxins11060359.
    De Icco R, et al. OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients With Lower Limb Spasticity. Toxins (Basel). 2019 Jun 20;11(6) PubMed PMID: 31226803.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity. AU - De Icco,Roberto, AU - Perrotta,Armando, AU - Berra,Eliana, AU - Allena,Marta, AU - Alfonsi,Enrico, AU - Tamburin,Stefano, AU - Serrao,Mariano, AU - Sandrini,Giorgio, AU - Tassorelli,Cristina, Y1 - 2019/06/20/ PY - 2019/05/05/received PY - 2019/05/20/revised PY - 2019/06/18/accepted PY - 2019/6/23/entrez KW - botulinum toxin KW - lower limb reflex KW - multiple sclerosis KW - neuropathic pain KW - spasticity KW - spinal cord injury KW - spinal temporal summation KW - stroke JF - Toxins JO - Toxins (Basel) VL - 11 IS - 6 N2 - Spasticity is a muscle tone disorder associated with different neurological conditions. Spasticity could be associated with pain, high disability, poor functional recovery, and reduced quality of life. Botulinum neurotoxin type A (BoNT-A) is considered a first-line treatment for spasticity and, more recently, it also represents a therapeutic option for various chronic pain conditions. In this open label study, we aim to evaluate the effect of the BoNT-A on the spinal nociception in patients affected by spasticity of the lower limbs with associated pain with predominantly neuropathic features. Ten patients with stroke, 10 with multiple sclerosis and 5 with spinal cord injury were enrolled in the study. They were tested with clinical scales (neuropathic pain scale inventory (NPSI), numerical rating scale (NRS), modified Ashworth scale (MAS) and with the nociceptive withdrawal reflex at lower limbs to explore the spinal temporal summation threshold at baseline and 30 day after BoNT-A injection. OnabotulinumtoxinA (50 to 200 units per site) was injected in the lower limb muscles according to the distribution of spasticity. No significant differences were found at baseline for neurophysiological features across groups. After the BoNT-A injection, we recorded a significant reduction in MAS and NRS scores. Regarding the neurophysiological parameters, we described a significant increase in the temporal summation threshold after the BoNT-A injection. Our data supports the hypothesis that peripherally injected OnabotulinumtoxinA modulates the excitability of spinal cord nociceptive pathways. This activity may take place irrespective of the effect of the drug on spasticity. SN - 2072-6651 UR - https://www.unboundmedicine.com/medline/citation/31226803/OnabotulinumtoxinA_Reduces_Temporal_Pain_Processing_at_Spinal_Level_in_Patients_with_Lower_Limb_Spasticity L2 - http://www.mdpi.com/resolver?pii=toxins11060359 DB - PRIME DP - Unbound Medicine ER -