Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force

J Neurol. 2016 Oct 27. [Epub ahead of print]

Dressler D¹, Bhidayasiri R², Bohlega S³, Chahidi A⁴, Chung TM⁵, Ebke M⁶, Jacinto LJ⁷, Kaji R⁸, Koçer S⁹, Kanovsky P¹⁰, Micheli F¹¹, Orlova O¹², Paus S¹³, Pirtosek Z¹⁴, Relja M¹⁵, Rosales RL¹⁶, Sagástegui-Rodríguez JA¹⁷, Schoenle PW¹⁸, Shahidi GA¹⁹, Timerbaeva S²⁰, Walter U²¹, Saberi FA²².

Author information

• ¹Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. dressler.dirk@mh-hannover.de.
• ²Chulalongkorn Centre for Excellence on Parkinson's Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
• ³Department of Neurology, King Faisal Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
• ⁴Basic and Clinical Neurosciences Research Laboratory, University Medical School of Marrakech, Marrakech, Morocco.
• ⁵University of Sao Paulo, Sao Paulo, Brazil.
• ⁶Department of Neurology, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht, Germany.
• ⁷Department of Adult Neuro-Rehabilitation, Adult Botulinum Toxin Clinics, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal.
• ⁸Department of Neurology, University of Tokushima, Tokushima, Japan.
• ⁹Centre de Rééducation et Medicine Physique, Hôpital du Jura, Porrentruy, Switzerland.
• ¹⁰Department of Neurology, Palacky University, Olomouc, Czech Republic.
• ¹¹Department of Neurology, Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina.
• ¹²Clinic 'Cecil Plus', Moscow, Russia.
• ¹³Department of Neurology, Bonn University, Bonn, Germany.
• ¹⁴Department of Neurology, Ljubljana University Medical Centre, Ljubljana, Slovenia.
• ¹⁵Department of Neurology, University of Zagreb, Zagreb, Croatia.
• ¹⁶Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines.
• ¹⁷Department of Neurology, Universidad de Monterrey, Monterrey, Mexico.
• ¹⁸Department of Neurology, Maternus-Klinik für Rehabilitation, Bad Oeynhausen, Germany.
• ¹⁹Department of Neurology, Movement Disorders Clinic, Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
• ²⁰Scientific Research Institute of Neurology, Moscow, Russia.
• ²¹Department of Neurology, Rostock University, Rostock, Germany.
• ²²IAB-Interdisciplinary Working Group for Movement Disorders, Hamburg, Germany.

Abstract

Botulinum toxin (BT) therapy is an established treatment of spasticity due to stroke. For multiple sclerosis (MS) spasticity this is not the case. IAB-Interdisciplinary Working Group for Movement Disorders formed a task force to explore the use of BT therapy for treatment of MS spasticity. A formalised PubMed literature search produced 55 publications (3 randomised controlled trials, 3 interventional studies, 11 observational studies, 2 case studies, 35 reviews, 1 guideline) all unanimously favouring the use of BT therapy for MS spasticity. There is no reason to believe that BT should be less effective and safe in MS spasticity than it is in stroke spasticity. Recommendations include an update of the current prevalence of MS spasticity and its clinical features according to classifications used in movement disorders. Immunological data on MS patients already treated should be analysed with respect to frequencies of MS relapses and BT antibody formation. Registration authorities should expand registration of BT therapy for spasticity regardless of its aetiology. MS specialists should consider BT therapy for symptomatic treatment of spasticity.

KEYWORDS:

Botulinum toxin; IAB-Interdisciplinary Working Group for Movement Disorders; Multiple sclerosis; Recommendations; Review; Spasticity; Therapeutic use