"This is 1 of the first studies to look at the effects of Botox treatment for MS spasticity, and we have also looked at the enhancement of the treatment through physiotherapy," said investigator and presenter Marina Giovannelli, MD, researcher, Saint Andreas Hospital MS Centre, University of Rome, Rome, Italy.

"The most important findings are that the botulinum toxin injections are very helpful to [patients with spasticity], and that this efficacy is significantly enhanced by specific stretching exercise physiotherapy following each injection treatment, which are repeated every 3 months."

The researchers studied 36 women and 4 men with MS, mean age of 48.7 years (range from 26 years to 63 years) and progressive disease. Their mean score on the Expanded Disability Status Scale (EDSS) was 6.0 (range from 3.5 to 7.5).

All of the subjects had severe spasticity, as measured by Ashworth scale (15 patients with a score of 3 and 25 patients with a score of 4). They were all treated with type A botulinum toxin (Botox) injections.

The investigators randomised 22 patients to Botox-plus-physiotherapy program, employing stretching rehabilitation for 15 consecutive days after the injection, and 18 patients to Botox injections alone. Six patient received 100 units of Botox injected into major muscles of upper limbs and 34 received a dose of 100-300 units of Botox in the lower extremity spastic muscles.

The researchers assessed subjects at weeks 2, 4, and 12 weeks posttreatment using the Ashworth Scale and Visual Analogue Scale for spasticity (VAS).

"There were no differences in the baseline characteristic of the 2 groups [ie age, sex, EDSS, and dosage of Botox injected]," the authors noted

The investigators reported a decrease of spasticity in both groups, but a significant positive group difference was found among those subjects who had received Botox in the lower extremity spastic muscles and undergone follow-up physiotherapy.

"Our data confirm that botulinum toxin type A significantly decreases spasticity in MS," The authors concluded. "Moreover, physiotherapy characterised by stretching rehabilitation program for 15 consecutive days after the injection improved overall response to botulinum toxin injection."


[Presentation title: Early Physiotherapy After Injection of Botulinum Toxin Increases the Beneficial Effects on Spasticity in Patients With Multiple Sclerosis. Poster # 374]

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