Early physiotherapy after injection of botulinum toxin (Bt) increases the beneficial effects on spasticity in patients with multiple sclerosis
ABSTRACT To determine whether additional physiotherapy increases botulinum toxin type A effects in reducing spasticity in patients with multiple sclerosis.
A single-blind, randomized, controlled pilot trial with a 12-week study period.
Thirty-eight patients with progressive multiple sclerosis affected by focal spasticity and who were observed at the Multiple Sclerosis Centre operating in the S. Andrea Hospital in Rome.
For intervention all patients received botulinum toxin type A; the treatment group also received additional physiotherapy to optimize management through passive or active exercise and stretching regimens.
To measure objective and subjective level of spasticity, patients were assessed at baseline, 2, 4 and 12 weeks post treatment by Modified Ashworth Scale and visual analogue scale.
When compared with the control group, we found a significant decrease of spasticity by Modified Ashworth Scale (P < 0.01 by t-test) in the treatment group at week 2 (2.73 versus 3.22), week 4 (2.64 versus 3.33) and week 12 (2.68 versus 3.33). The mean (%) difference in Modified Ashworth Scale score between baseline and the end of follow-up was -0.95 (26.1) in the treatment group and -0.28 (7.7) in the control group (P < 0.01). The combined treatment proved also to be more effective by visual analogue scale (P < 0.01) at week 4 (6.95 versus 5.50) and at week 12 (7.86 versus 6.56) but not at week 2 (5.18 versus 5.50; P = 0.41).
Our data suggest that physiotherapy in combination with botulinum toxin type A injection can improve overall response to botulinum toxin.
- SourceAvailable from: Maurizio Bifulco
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- "Physiotherapy for the relief of spasticity in MS (Giovannelli et al 2007; Pöllmann and Feneberg 2008), has not been extensively studied, despite being the standard approach, is insuffi cient alone for most patients, thus antispastic drugs are required. Among these antispastic drugs, the most commonly used are tizanidine and baclofen. "
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ABSTRACT: La spasticité est un symptôme fréquent dans la sclérose en plaques (SEP). Le traitement dépend du caractère focal ou diffus de la spasticité. Les recommandations récentes de l’Afssaps permettent de préciser le traitement de première intention: toxine botulique A dans la spasticité focale, baclofène intrathécal (BIT) dans la spasticité diffuse. Une évaluation préalable en s’aidant de tests réversibles permet de définir les objectifs fonctionnels du traitement. Spasticity is a frequent symptom in cases of multiple sclerosis. The treatment depends on whether the spasticity is focal or diffuse. The recent recommendations issued by AFSSAPS give details concerning first-line therapy: botulinum toxin A for cases of focal spasticity and intrathecal baclofen for diffuse spasticity. A prior evaluation can be made with the help of reversible tests to set out the functional objectives of the therapy. Mots clésSclérose en plaques–Spasticité–Traitement KeywordsMultiple sclerosis–Spasticity–TreatmentLa Lettre de médecine physique et de réadaptation 12/2010; 26(4):167-170. DOI:10.1007/s11659-010-0252-x