109. Pain other than headaches

109. Pain other than headaches


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Abstracts / Toxicon 93 (2015) S2eS67

107. INFILTRATION WITH BOTULINUM NEUROTOXIN A (XEOMIN) IN FLEXIBLE INTERVALS TO REACH APPROPRIATE MODULATION OF SPASTICITY Giancarlo Ianieri*, E. Romanelli, L. Mastromauro, R. Marvulli, G.B. Marzo Neurorehabilitation, Policlinico of Bari, Bari, Puglia, Italy *Corresponding author: Neurorehabilitation, Policlinico of Bari, Bari, Puglia 70124, Italy. E-mail address: [email protected]

Introduction and Objectives: Current standard treatment for patients with spasticity includes botulinum toxin infiltrations at intervals of no less than 3 months. However, in clinical practice, some patients need more closely spaced treatments in order to adequately modulate spastic hypertonia and to ensure their satisfaction. The aim of this study was to investigate whether reduction of intervals between incobotulinumtoxin A (Xeomin) infiltrations results in a significant reduction of treatment clinical efficacy over time or a rise in adverse reactions. Methods: We evaluated the effects of flexible intervals of incobotulinumtoxin A infiltrations (6, 12, 16 weeks) in 28 patients with left spasticity treated for a period of 16 months. We analyzed 3 parameters: patient satisfaction (outcome), Modified Ashworth Scale (MAS), and myotonometry (MYO), which represents a noninvasive way to characterize the viscoelastic properties (tone, elasticity, stiffness) of skeletal muscles. Statistical analysis was performed using one-way ANOVA. Results: Therapeutic effect of infiltration at different time intervals was maintained constant in time (P<0.05). Conclusions: The opportunity to reduce the time between infiltrations is due to the pharmacologic properties of incobotulinumtoxin A, which is free from complexing proteins. Infiltrations administered at flexible intervals (6 to 16 weeks) were well tolerated by patients and modulated the spasticity satisfactorily, allowing a personalized treatment. Last, we found that the therapeutic effect of this new strategy remains constant over time.


Animal studies indicate an analgesic effect for botulinum neurotoxins (BoNTs) via inhibition of pain mediator release, decreased inflammation, and other mechanisms. In the past 10 years, a number of high-quality studies have been published suggesting or indicating the efficacy of BoNTs in relieving different types of neuropathic pain. Using the efficacy criteria recommended by the Assessment Subcommittee of the American Academy of Neurology (French 2008), the use of BoNTs for neck pain of cervical dystonia, postherpetic neuralgia, and pain of chronic lateral epicondylitis meets the level of evidence established for a Level A recommendation (2 or more class I studies). For post-traumatic neuralgia, plantar fasciitis, trigeminal neuralgia, piriformis syndrome, and pain associated with total knee arthroplasty, the evidence supports a level B rating: probably effective based on availability of 1 class I or 2 class II studies. BoNTs are possibly effective (Level C) in allodynia of diabetic neuropathy, pelvic pain, painful knee osteoarthritis, low back pain, postoperative pain in children with cerebral palsy after adductor release surgery, anterior knee pain with vastus lateralis imbalance, postoperative pain after mastectomy, anal sphincter spasms, and pain after hemorrhoidectomy (1 class II study). For carpal tunnel syndrome and phantom pain, 1 class I study showed significant difference compared with placebo (Level B, probably ineffective). The positive results of BoNT therapy in postherpetic neuralgia, post-traumatic neuralgia, trigeminal neuralgia and plantar fasciitis is a major development in pain medicine, since these disorders are common and the patients are often not satisfied with their current level of pain relief. It is anticipated that careful future clinical trials aiming to find the optimum dose, injection sites, and primary outcomes will improve the level of evidence for BoNTs in other areas of human pain. Reference French J, Gronseth G. Lost in a jungle of evidence: We need a compass. Neurology. 2008;71:1634-1638. 110. FACTORS INFLUENCING GOAL ATTAINMENT IN PATIENTS WITH POSTSTROKE UPPER LIMB SPASTICITY FOLLOWING TREATMENT WITH BOTULINUM NEUROTOXIN A IN REAL-LIFE CLINICAL PRACTICE: SUBANALYSES FROM THE UPPER LIMB INTERNATIONAL SPASTICITY (ULIS)-II STUDY Jorge Jacinto a,*, Klemens Fheodoroff b, Stephen Ashford c, Pascal Maisonobe d, Jovita Balcaitiene d, Lynne Turner-Stokes c a ~o Center of Rehabilitation Medicine, Cascais, Portugal; b GailtalAlcoita Klinik, Hermagor, Austria; c Regional Rehabilitation Unit, Northwick Park Hospital, Middlesex, UK; d Ipsen Pharma, Boulogne-Billancourt, France ~o Center of Rehabilitation Medicine, Serviço de *Corresponding author: Alcoita ~o de Adultos 3, Rua Conde Bara ~o, Alcabideche, Cascais 2649-506, Reabilitaça Portugal. E-mail address: [email protected]


Keywords: New strategy; Spasticity References €mper P. Essential blepharospasm: Practice-oriented Wabbels B, Roggenka therapy with botulinum toxin employing reduced treatment intervals. Ophthalmologe. 2012;109(1):45-53. Bakheit AM, Liptrot A, Newton R, Pickett AM. The effect of total cumulative dose, number of treatment cycles, interval between injections, and length of treatment on the frequency of occurrence of antibodies to botulinum toxin type A in the treatment of muscle spasticity. Int J Rehabil Res. 2012 Mar;35(1):36-39. 108. MAXIMIZING OUTCOMES IN SPASTICITY USING BONT Cindy Ivanhoe Baylor College of Medicine, 1333 Moursund Avenue, D110, Houston, TX 77030, USA. E-mail address: [email protected] 109. PAIN OTHER THAN HEADACHES Bahman Jabbari Department of Neurology, Yale University, LCI 920 C, 15 York Street, New Haven, CT 06510, USA. E-mail address: [email protected]

Introduction and Objectives: In ULIS-II, botulinum neurotoxin A (BoNT/A) treatment of poststroke upper limb spasticity (ULS) had a clinically significant impact on attainment of person-centered primary goals of rehabilitation, as measured by goal attainment scaling. This post-hoc analysis aimed to determine factors that influenced goal setting and achievement in ULIS-II. Methods: Patients' (N¼456, from 84 centers in 22 countries) baseline characteristics, impairment severity, and achievement of primary goals were identified in relation to passive function, active function, or pain goals. Impact of time elapsed since stroke to BoNT/A in ULIS-II, presence of severe soft tissue shortening (STS), and intensity of therapeutic input (TI) on goal setting and achievement were also analyzed. Results: Patients who set passive-function primary goals had greater motor impairment (P<0.001), STS (P¼0.006), and spasticity (P¼0.02) than those who set other primary goals. Patients with active-function primary goals had less motor impairment (P<0.0001), STS (P<0.0001), and spasticity (P<0.001), and shorter time since stroke (P¼0.001). Patients with primary pain goals were older (P¼0.01), with more STS (P¼0.008). Primary-goal achievement rates were similar between patients with 1 year (medium) and >1 year (longer) time from stroke to inclusion in ULIS-II (76.6% vs 80.2%) and with or without STS (76.7% vs 80.6%). Patients with a longer interval after stroke (>1 year) were still capable of achieving their individual goal set (74%). Primary-goal achievement was greater in patients receiving high- compared with low-intensity TI (83.6% vs 74.6%; P<0.05) during the study. Primary-goal setting was influenced by