Early physiotherapy after injection of botulinum toxin (Bt) increases the beneficial effects on spasticity in patients with multiple sclerosis

Sapienza University of Rome, Roma, Latium, Italy
Clinical Rehabilitation (Impact Factor: 2.24). 05/2007; 21(4):331-7. DOI: 10.1177/0269215507072772
Source: PubMed


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.

26 Reads
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The endocannabinoid system and cannabinoid-based treatments have been involved in a wide number of diseases. In particular, several studies suggest that cannabinoids and endocannabinoids may have a key role in the pathogenesis and therapy of multiple sclerosis (MS). In this study we highlight the main findings reported in literature about the relevance of cannabinoid drugs in the management and treatment of MS. An increasing body of evidence suggests that cannabinoids have beneficial effects on the symptoms of MS, including spasticity and pain. In this report we focus on the effects of cannabinoids in the relief of spasticity describing the main findings in vivo, in the mouse experimental allergic encephalomyelitis model of MS. We report on the current treatments used to control MS symptoms and the most recent clinical studies based on cannabinoid treatments, although long-term studies are required to establish whether cannabinoids may have a role beyond symptom amelioration in MS.
    Neuropsychiatric Disease and Treatment 11/2008; 4(5):847-53. · 1.74 Impact Factor
  • [Show abstract] [Hide abstract]
    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–Treatment
    La Lettre de médecine physique et de réadaptation 12/2010; 26(4):167-170. DOI:10.1007/s11659-010-0252-x
  • [Show abstract] [Hide abstract]
    ABSTRACT: Als »Matratzengruft« hatte der Dichter Heinrich Heine seine letzte Bleibe 1856 beschrieben und seinen Zustand als ein Unleben, das nicht zu ertragen sei. Seine Multiple Sklerose hatte ihn ans Bett gefesselt, ihn seiner Autonomie beraubt und ihm die Lebenslust entrissen.
Show more