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Hull M, Danchenko N, Anupindi VR, DeKoven M, He J, Bouchard J. Health care resource utilization and costs among patients with spasticity or cervical dystonia. J Manag Care Spec Pharm 2024; 30:86-97. [PMID: 38055046 PMCID: PMC10775770 DOI: 10.18553/jmcp.2023.22205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Spasticity and cervical dystonia (CD) are movement disorders with considerable direct and indirect health care cost implications. Although several studies have discussed their clinical impact, few have calculated the economic burden of these disorders. OBJECTIVE To assess the all-cause health care resource utilization (HCRU) and costs in adults and children with spasticity or CD. METHODS This retrospective, observational cohort-based study was conducted using administrative insurance claims from the IQVIA PharMetrics Plus database from October 1, 2015, to December 31, 2019. Patients were selected based on International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for first evidence of spasticity (associated with a spasticity etiology) or CD (index date) during the selection window, from April 1, 2016, through December 31, 2018. Cases were stratified into 3 mutually exclusive cohorts: adult patients with spasticity, pediatric patients with spasticity, and patients with CD; those with spasticity who had a history of stroke or cerebral palsy were also evaluated in subcohorts. Patients without evidence of spasticity or CD during the study period were identified as a matched comparator group and were randomly assigned an index date. Patients with spasticity were matched 1:1 to the comparator group based on age, sex, index year, and payer type using descriptive analyses. RESULTS 215,739 adult patients with spasticity, 29,644 pediatric patients with spasticity, and 9,035 adult patients with CD were identified after matching. Adult patients with spasticity and CD had mean (SD) ages of 48.4 (15.6) years and 48.0 (13.1) years, respectively. Stroke was identified in 31.9% (n = 68,928) of adult patients with spasticity, and cerebral palsy was identified in 11.3% (n = 3,364) of pediatric patients with spasticity. Adult and pediatric patients with spasticity and patients with CD had significantly higher HCRU (including mean number of outpatient, emergency department, and inpatient visits and proportions of patients with prescription fills) and higher mean total health care costs per patient (adult patients with spasticity $29,912 vs $7,464; pediatric patients with spasticity $16,089 vs $2,963; and patients with CD $20,168 vs $7,141) than matched comparators (all P<0.0001). CONCLUSIONS The management of patients with spasticity or CD results in considerably higher health care expenses. Within managed health care systems, more effective management of spasticity and CD in adult and pediatric patients represents a significant opportunity for cost savings.
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Lindsay C, Humphreys I, Phillips C, Pandyan A. Estimating the cost consequence of the early use of botulinum toxin in post-stroke spasticity: Secondary analysis of a randomised controlled trial. Clin Rehabil 2023; 37:373-380. [PMID: 36325678 PMCID: PMC9912301 DOI: 10.1177/02692155221133522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To estimate the cost-consequence of treating spasticity early with botulinum toxin in the acute stroke unit. DESIGN Secondary cost-consequence analysis, using data from a double-blind randomised-controlled trial. SETTING Single-centre specialised stroke unit. SUBJECTS AND INTERVENTIONS Patients with Action Research Arm Test grasp-score of <2 and who developed spasticity within six weeks of a first stroke were randomised to receive injections of: 0.9% sodium-chloride solution (placebo) or onabotulinumtoxin-A (treatment). MAIN MEASURES Resource use costs were calculated for the study. Mean contracture costs for each group were calculated. The Barthel Index and Action Research Arm Test were used to generate a cost per unit of improvement. RESULTS There were no significant differences associated with early treatment use. The mean contracture cost for the treatment group was £817 and for the control group was £2298 (mean difference = -£1481.1(95% CI -£2893.5, -£68.7) (p = 0.04). The cost per unit of improvement for the Barthel Index was -£1240 indicating that the intervention costs less and is more effective. The cost per unit of improvement for the Action Research Arm Test was -£450 indicating that the intervention costs less and is more effective. CONCLUSIONS Treating spasticity early in stroke patients at risk of contractures with botulinum toxin leads to a significant reduction in contracture costs. The cost per improvement of Barthel and Action Research Arm Test indicates that the intervention costs less and is more effective. TRIAL REGISTRATION DATA EudraCT(2010-021257-39) and ClinicalTrials.gov-Identifier:NCT01882556.
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Affiliation(s)
- Cameron Lindsay
- 46 Bangor Road, Holywood, Down, UK
- Cameron Lindsay, 46 Bangor Road, Holywood,
Down, BT18 0LQ, UK.
| | - Ioan Humphreys
- Swansea University, First Floor, Vivian Building, Singleton Campus,
Swansea, UK
| | - Ceri Phillips
- Swansea University, First Floor, Vivian Building, Singleton Campus,
Swansea, UK
| | - Anand Pandyan
- Bournemouth University, Bournemouth Gateway Building (Rm 507), St
Pauls Lane, Bournemouth, UK
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Banky M, Clark RA, Mentiplay BF, Olver JH, Kahn MB, Williams G. Toward Accurate Clinical Spasticity Assessment: Validation of Movement Speed and Joint Angle Assessments Using Smartphones and Camera Tracking. Arch Phys Med Rehabil 2019; 100:1482-1491. [PMID: 30684484 DOI: 10.1016/j.apmr.2018.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/09/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether a three-dimensional (3-D) camera (Microsoft Kinect) and a smartphone can be used to accurately quantify the joint angular velocity and range of motion (ROM) compared to a criterion-standard 3-D motion analysis system during a lower limb spasticity assessment. DESIGN Observational, criterion-standard comparison study. SETTING Large rehabilitation center. PARTICIPANTS A convenience sample of 35 controls, 35 patients with a neurologic condition, and 34 rehabilitation professionals (physiotherapists and rehabilitation doctors) participated (N=104). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Modified Tardieu Scale was used to assess spasticity of the quadriceps, hamstrings, soleus, and gastrocnemius. Data for each trial were collected concurrently using the criterion-standard Optitrack 3-D motion analysis (3DMA) system, Microsoft Kinect, and a smartphone. Each healthy control participant was assessed by 1 health professional and each patient with a neurological condition was assessed by 3 health professionals. Spearman correlation coefficient and intraclass correlation coefficient with 95% confidence intervals were used to report the strength of the relationships investigated. RESULTS The smartphone and Microsoft Kinect demonstrated excellent concurrent validity with the 3DMA system. Overall, 74.8% of the relationships investigated demonstrated a very strong (≥0.80) correlation across all of the testing parameters. The Microsoft Kinect was superior to the smartphone for measuring joint start and end angle, the smartphone was superior for measuring joint angular velocity, and the 2 systems were comparable for measuring total joint ROM. CONCLUSIONS These findings provide preliminary evidence that user-friendly, low-cost technologies can be used to facilitate accurate measurements of joint angular velocity and angles during a lower limb spasticity assessment in a clinical setting.
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Affiliation(s)
- Megan Banky
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia; School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia.
| | - Ross A Clark
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Benjamin F Mentiplay
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - John H Olver
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Michelle B Kahn
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia; School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Gavin Williams
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia
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Raluy-Callado M, Cox A, MacLachlan S, Bakheit AM, Moore AP, Dinet J, Gabriel S. A retrospective study to assess resource utilization and costs in patients with post-stroke spasticity in the United Kingdom. Curr Med Res Opin 2018; 34:1317-1324. [PMID: 29490512 DOI: 10.1080/03007995.2018.1447449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Post-stroke spasticity (PSS) is a common complication following stroke. This study describes the differences in healthcare resource utilization between patients who do and do not develop PSS in the UK. METHODS Adults registered in The Health Improvement Network database with a recorded stroke between 2007 and 2011 were included. PSS was identified through Read codes; machine learning was used to retrospectively identify unrecorded PSS events. Patients with diagnosed or predicted PSS in the 12 months after stroke were matched to those with no PSS on age, sex, number of strokes, socioeconomic status, and comorbidities using the nearest neighbor algorithm. Utilization and costs associated with general practitioner visits, nurse visits, hospitalizations, referrals to specialists, laboratory tests, and medications in the 12 months after stroke were compared. RESULTS Overall, 2,951 PSS cases were matched to 37,753 controls. During the first year, more PSS cases visited a physiotherapist (19% vs 7%) and occupational therapist (12% vs 5%) compared to controls. A greater proportion of cases were also referred to specialists (76% vs 64%) and hospitalized (33% vs 9%) compared to controls. Medication for spasticity was, on average, 14.68 prescriptions for cases and 5.64 for controls. Total mean costs per patient were £1,270 (standard deviation [SD] = 772) and £635 (SD = 273) for cases and controls, respectively. CONCLUSION Costs after stroke for patients developing PSS are twice as high compared to patients who do not develop it, with the major driver being the number of hospital admissions. This highlights the need for better recording and closer management of PSS.
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Affiliation(s)
| | | | | | | | - A Peter Moore
- c The Walton Centre NHS Foundation Trust , Liverpool , UK
| | - Jerome Dinet
- d Ipsen Pharma SAS , Boulogne-Billancourt , France
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Srivastava S, Agarwal MP, Gautam A. Post Stroke Psychosis Following Lesions in Basal Ganglion. J Clin Diagn Res 2017; 11:VD01-VD02. [PMID: 28658884 PMCID: PMC5483786 DOI: 10.7860/jcdr/2017/24142.9790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/21/2017] [Indexed: 11/24/2022]
Abstract
Stroke is the second most common cause of death and fourth leading cause of disability worldwide. Post stroke behavioural manifestations are often not recognized, undiagnosed and hence remain untreated. They may even suffer from misdiagnosis of functional disorders before coming at conclusion of organic pathology. Early diagnosis and prompt treatment helps in lowering the overall morbidity related to stroke and improves quality of life of these patients with rare manifestations. Here, we report two cases of elderly female patients presenting with delusions and hallucinations subsequent to stroke, with lesions in basal ganglia detected on neuro-imaging.
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Affiliation(s)
- Shruti Srivastava
- Professor, Department of Psychiatry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Mukul P Agarwal
- Professor, Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Ankur Gautam
- Post Graduate Student, Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Santamato A, Micello MF, Ranieri M, Valeno G, Albano A, Baricich A, Cisari C, Intiso D, Pilotto A, Logroscino G, Panza F. Employment of higher doses of botulinum toxin type A to reduce spasticity after stroke. J Neurol Sci 2015; 350:1-6. [PMID: 25684341 DOI: 10.1016/j.jns.2015.01.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/07/2015] [Accepted: 01/30/2015] [Indexed: 11/30/2022]
Abstract
Spasticity is a common disabling symptom for several neurological conditions. Botulinum toxin type A injection represents the gold standard treatment for focal spasticity with efficacy, reversibility, and low prevalence of complications. Current guidelines suggest a dose up to 600 units (U) of onabotulinumtoxinA/incobotulinumtoxinA or up to 1,500 U of abobotulinumtoxinA to treat post-stroke spasticity to avoid important adverse effects. However, recently, higher doses of botulinum toxin type A were employed, especially in case of upper and lower limb severe spasticity. With searches of US National Library of Medicine databases, we identified all studies published from December 1989 to July 2014 concerning the use of higher doses of this neurotoxin for spasticity treatment with at least a dose of 600 U of onabotulinumtoxinA and incobotulinumtoxinA or 1,800 U of abobotulinumtoxinA. The cumulative body of evidence coming from the eight studies selected suggested that higher doses of botulinum toxin type A appeared to be efficacious in reducing spasticity of the upper and lower limbs after stroke, with adverse effects generally mild. However, further investigations are needed to determine the safety and reproducibility in larger case series or randomized clinical trials of higher doses of botulinum toxin type A also after repeated injections.
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Affiliation(s)
- Andrea Santamato
- Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy.
| | - Maria Francesca Micello
- Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy
| | - Maurizio Ranieri
- Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy
| | - Giovanni Valeno
- Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy
| | - Antonio Albano
- Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Carlo Cisari
- Physical Medicine and Rehabilitation, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Domenico Intiso
- Department of Neuro-Rehabilitation IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Alberto Pilotto
- Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy; Geriatric Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padova, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Francesco Panza
- Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy; Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
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7
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Current uses of botulinum toxin A as an adjunct to hand therapy interventions of hand conditions. J Hand Ther 2014; 27:85-94; quiz 95. [PMID: 24524884 DOI: 10.1016/j.jht.2013.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Literature review. DISCUSSION Botulinum toxin A, a neurotoxin causing temporary muscle paralysis at the neuromuscular junction, has been used to treat multiple acquired conditions of the hand and upper extremity. Initially approved for use in treating blepharospasm and strabismus in the 1980s, indications have expanded to include spasticity associated with cerebrovascular accidents, vasospastic disorders, focal dystonias, and pain conditions. This article reviews the current literature discussing the efficacy of botulinum toxin A in management of disorders of the hand and upper extremity relevant to hand therapists. LEVEL OF EVIDENCE NA.
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8
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Doan QV, Gillard P, Brashear A, Halperin M, Hayward E, Varon S, Lu ZJ. Cost-effectiveness of onabotulinumtoxinA for the treatment of wrist and hand disability due to upper-limb post-stroke spasticity in Scotland. Eur J Neurol 2012; 20:773-80. [DOI: 10.1111/ene.12062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 11/01/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Q. V. Doan
- Outcomes Insights, Inc.; Westlake Village; CA; USA
| | | | - A. Brashear
- Department of Neurology; Wake Forest Baptist Medical Center; Winston Salem; NC; USA
| | - M. Halperin
- Outcomes Insights, Inc.; Westlake Village; CA; USA
| | - E. Hayward
- Allergan, Ltd., Marlow International; Buckinghamshire; UK
| | | | - Z. J. Lu
- Outcomes Insights, Inc.; Westlake Village; CA; USA
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Wissel J, auf dem Brinke M, Hecht M, Herrmann C, Huber M, Mehnert S, Reuter I, Schramm A, Stenner A, van der Ven C, Winterholler M, Kupsch A. [Botulinum toxin in the treatment of adult spasticity. An interdisciplinary German 10-point consensus 2010]. DER NERVENARZT 2011; 82:481-95. [PMID: 21079908 DOI: 10.1007/s00115-010-3172-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Spasticity is one of the major causes of functional impairment in adults with lesions of the central nervous system. For instance, approximately 30% of post-stroke patients suffer from different degrees of spasticity with possible consecutive impairments. Numerous studies or meta-analyses showed that local injections of botulinum toxin in spastic muscles lead to dose-dependent reduction in muscle tone and improvement of passive movements (e. g. facilitated care), especially following repeated injections.However, country-specific regulations and patient-remote administration in German health care often do not allow adequate provision of this therapy. Thus, the present consensus statement based on the EBM analyses of the published international literature tries to highlight recent advances and the standard in the field of local spasticity treatment, aiming to facilitate communication between the decision makers and German reimbursement institutions in health care. Prior to initiation of BoNT-A injections, patient-oriented goals should be identified in a multiprofessional context to assure realistic goals for this specific treatment and patient expectations. In Germany for the treatment of focal spasticity following stroke three products have been approved: Botox® (Pharm Allergan, Ettlingen), Dysport® (Ipsen Pharma, Ettlingen) and Xeomin® (Merz Pharma, Frankfurt/Main). For all preparations safety has been repeatedly shown. Functional improvements have also been illustrated for selected patients concerning hand/arm function and gait. The dose per muscle and the selection of muscles to be injected have to be individualized according to the patient's symptoms and should be accompanied by modern neurorehabilitative therapies such as redression or repetitive activation of the injected and antagonistic muscles.
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Affiliation(s)
- J Wissel
- Kliniken Beelitz GmbH, Paracelsusring 6 A, 14547, Beelitz-Heilstätten.
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10
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Lim SJ, Park HJ, Lee SH, Moon DE. Ganglion impar block with botulinum toxin type a for chronic perineal pain -a case report-. Korean J Pain 2010; 23:65-9. [PMID: 20552077 PMCID: PMC2884216 DOI: 10.3344/kjp.2010.23.1.65] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 11/26/2009] [Accepted: 12/17/2009] [Indexed: 11/05/2022] Open
Abstract
Chronic perineal pain is an often encountered problem, which produces a great degree of functional impairment and frustration to the patient and a challenge to the treating physician. The reason for this problem is that the region contains diverse anatomic structures with mixed somatic, visceral and autonomic innervations affecting bladder and bowel control and sexual function. A blockade of nociceptive and sympathetic supply to the perineal region, supplied through the ganglion impar has been shown to benefit patients with chronic perineal pain. Several options to this block have been described that chemical neurolysis, radiofrequency ablation etc. Although the analgesic effect of Botulinum toxin type A (BoNT-A) has long been considered secondary to its action for muscle relaxation, BoNT-A also affects the release of the neurotransmitters that are involved in pain perception. We describe a patient who was successfully given ganglion impar block with BoNT-A.
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Affiliation(s)
- Su Jin Lim
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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11
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Lundström E, Smits A, Borg J, Terént A. Four-Fold Increase in Direct Costs of Stroke Survivors With Spasticity Compared With Stroke Survivors Without Spasticity. Stroke 2010; 41:319-24. [DOI: 10.1161/strokeaha.109.558619] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erik Lundström
- From the Departments of Neuroscience and Neurology (E.L., A.S.), the Department of Medical Sciences, Stroke Unit (A.T.), and the Departments of Neuroscience and Rehabilitation Medicine (E.L., J.B.), Uppsala University Hospital, Uppsala, Sweden
| | - Anja Smits
- From the Departments of Neuroscience and Neurology (E.L., A.S.), the Department of Medical Sciences, Stroke Unit (A.T.), and the Departments of Neuroscience and Rehabilitation Medicine (E.L., J.B.), Uppsala University Hospital, Uppsala, Sweden
| | - Jörgen Borg
- From the Departments of Neuroscience and Neurology (E.L., A.S.), the Department of Medical Sciences, Stroke Unit (A.T.), and the Departments of Neuroscience and Rehabilitation Medicine (E.L., J.B.), Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Terént
- From the Departments of Neuroscience and Neurology (E.L., A.S.), the Department of Medical Sciences, Stroke Unit (A.T.), and the Departments of Neuroscience and Rehabilitation Medicine (E.L., J.B.), Uppsala University Hospital, Uppsala, Sweden
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The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2010; 14:45-66. [PMID: 19914110 DOI: 10.1016/j.ejpn.2009.09.005] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/15/2009] [Accepted: 09/17/2009] [Indexed: 12/20/2022]
Abstract
An interdisciplinary European group of clinical experts in the field of movement disorders and experienced Botulinum toxin users has updated the consensus for the use of Botulinum toxin in the treatment of children with cerebral palsy (CP). A problem-orientated approach was used focussing on both published and practice-based evidence. In part I of the consensus the authors have tabulated the supporting evidence to produce a concise but comprehensive information base, pooling data and experience from 36 institutions in 9 European countries which involves more than 10,000 patients and over 45,000 treatment sessions during a period of more than 280 treatment years. In part II of the consensus the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) based Motor Development Curves have been expanded to provide a graphical framework on how to treat the motor disorders in children with CP. This graph is named "CP(Graph) Treatment Modalities - Gross Motor Function" and is intended to facilitate communication between parents, therapists and medical doctors concerning (1) achievable motor function, (2) realistic goal-setting and (3) treatment perspectives for children with CP. The updated European consensus 2009 summarises the current understanding regarding an integrated, multidisciplinary treatment approach using Botulinum toxin for the treatment of children with CP.
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13
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Elovic EP, Esquenazi A, Alter KE, Lin JL, Alfaro A, Kaelin DL. Chemodenervation and Nerve Blocks in the Diagnosis and Management of Spasticity and Muscle Overactivity. PM R 2009; 1:842-51. [DOI: 10.1016/j.pmrj.2009.08.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 08/06/2009] [Indexed: 01/04/2023]
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Mohammadi B, Balouch SA, Dengler R, Kollewe K. Long-term treatment of spasticity with botulinum toxin type A: an analysis of 1221 treatments in 137 patients. Neurol Res 2009; 32:309-13. [PMID: 19726016 DOI: 10.1179/016164109x12478302362734] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Spasticity is a complex disorder that causes significant disability in affected patients. We here present long-term results of botulinum toxin type A (BoNT-A) treatment in spasticity of various etiologies in the upper and lower limbs. PATIENTS AND METHODS We evaluated long-term results of BoNT-A treatment with Dysport and Botox for up to 12 years in 137 patients with spasticity of various etiologies. The focus was laid on efficacy, dosage, safety and side effects over time in a retrospective analysis of the database of our movement disorder clinic. RESULTS The mean clinical benefit, latency and duration of response were comparable for both products. Side effects were generally mild and comparable for the two products. We found a significant negative correlation between time from onset of spasticity to start of BoNT-A treatment and degree of improvement after treatment. CONCLUSION Our data confirm the safety and efficacy of BoNT-A treatment of spasticity of different etiologies over a long period of time. Furthermore, the data imply that BoNT-A treatment should be started early after appearance of spasticity to obtain better treatment response.
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Affiliation(s)
- B Mohammadi
- Department of Neurology and Clinical Neurophysiology, Medical School Hannover, Hannover, Germany.
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Affiliation(s)
- Archana Rao
- Department of Endo-Gynaecology, Royal Hospital for Women, Randwick, New South Wales, Australia.
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Fock J, Galea MP, Stillman BC, Rawicki B, Clark M. Functional outcome following Botulinum toxin A injection to reduce spastic equinus in adults with traumatic brain injury. Brain Inj 2009; 18:57-63. [PMID: 14660236 DOI: 10.1080/0269905031000149498] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PRIMARY OBJECTIVE The aim of this study was to assess the effect of Botulinum toxin A in the management of spastic equinus resulting from traumatic brain injury. RESEARCH DESIGN A before-after intervention design was used without controls. METHODS AND PROCEDURES Subjects were seven patients suffering from traumatic brain injury of average duration 14 (4-38) months as a result of motor vehicle trauma, who had spastic equinus interfering with gait. EXPERIMENTAL INTERVENTION The patients were treated with injections of Botulinum toxin A into the spastic calf muscles: gastrocnemius, soleus and tibialis posterior. Assessments were made pre-injection and at 2 weeks and 3 months post-injection. MAIN OUTCOME AND RESULTS At the end of the 3-month period, all patients showed a significant improvement in gait velocity, cadence and stride length. CONCLUSIONS The findings suggest that Botulinum toxin A may be useful in the management of spastic equinus following traumatic brain injury.
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Affiliation(s)
- Jimy Fock
- Brighton Rehabilitation Centre, Victoria, Australia
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Abbott J. The Use of Botulinum Toxin in the Pelvic Floor for Women with Chronic Pelvic Pain–A New Answer to Old Problems? J Minim Invasive Gynecol 2009; 16:130-5. [DOI: 10.1016/j.jmig.2008.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 10/21/2008] [Accepted: 11/06/2008] [Indexed: 10/21/2022]
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Lim ECH, Seet RCS. Botulinum toxin: description of injection techniques and examination of controversies surrounding toxin diffusion. Acta Neurol Scand 2008; 117:73-84. [PMID: 17850405 DOI: 10.1111/j.1600-0404.2007.00931.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The benefits derived from botulinum toxin (BTX) injections may be negated by unintentional weakness of adjacent uninjected muscles. Such weakness may be the result of inaccurate targeting, or diffusion of BTX to surrounding muscles. Several techniques, using electromyographic, endoscopic or imaging guidance are purported to increase the accuracy of targeting. Diffusion of BTX is thought to be influenced by factors such as dose, concentration, injectate volume, number of injections, site and rate of injection, needle gauge, muscle size, muscular fascia, distance of needle tip from the neuromuscular junction, and protein content of the BTX formulation. This article describes techniques that aim to increase the accuracy of BTX injections and examines the controversies surrounding diffusion of BTX following injection.
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Affiliation(s)
- E C-H Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, and National University Hospital, Singapore.
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Botulinumtoxin für Kinder mit Zerebralparesen: 10-Punkte-Tabelle, 2007. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-007-1516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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McClelland S, Teng Q, Benson LS, Boulis NM. Motor neuron inhibition-based gene therapy for spasticity. Am J Phys Med Rehabil 2007; 86:412-21. [PMID: 17449986 DOI: 10.1097/phm.0b013e31804a83cf] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Spasticity is a condition resulting from excess motor neuron excitation, leading to involuntary muscle contraction in response to increased velocity of movement, for which there is currently no cure. Existing symptomatic therapies face a variety of limitations. The extent of relief that can be delivered by ablative techniques such as rhizotomy is limited by the potential for sensory denervation. Pharmacological approaches, including intrathecal baclofen, can be undermined by tolerance. One potential new approach to the treatment of spasticity is the control of neuromuscular overactivity through the delivery of genes capable of inducing synaptic inhibition. A variety of experiments in cell culture and animal models have demonstrated the ability of neural gene transfer to inhibit neuronal activity and suppress transmission. Similarly, enthusiasm for the application of gene therapy to neurodegenerative diseases of motor neurons has led to the development of a variety of strategies for motor neuron gene delivery. In this review, we discuss the limitations of existing spasticity therapies, the feasibility of motor neuron inhibition as a gene-based treatment for spasticity, potential inhibitory transgene candidates, strategies for control of transgene expression, and applicable motor neuron gene targeting strategies. Finally, we discuss future directions and the potential for gene-based motor neuron inhibition in therapeutic clinical trials to serve as an effective treatment modality for spasticity, either in conjunction with or as a replacement for presently available therapies.
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Affiliation(s)
- Shearwood McClelland
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Rousseaux M, Daveluy W. Place des doses élevées dans les injections de toxine botulique. ACTA ACUST UNITED AC 2007; 50 Suppl 1:S1-3. [PMID: 17550809 DOI: 10.1016/s0168-6054(07)80001-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To bring general elements of reflection on the use of the high doses of botulinum toxin in spastic children and adults. MATERIAL AND METHODS Review of the literature on the high doses and the benefit-risk associated with botulinum toxin injections. RESULTS The medical literature exclusively relates to the use of the high doses in children and adolescents. Comparative work with conventional doses suggests a relative interest, but with a risk of increased side effects. Several articles report on treatments with high and even very high doses in series of patient, with a documented effectiveness. But their justification remains partial and the study of the possible side effects is limited. Reflections are brought to contribute to the debate on the use of high doses, taking into account the local physiological effect of botulinum toxin, the risk of regional and general diffusion, the need for a progressive strategy, the variability of effects, the cost of the treatment and the need for obtaining an informed consent of the patient and of significant others. CONCLUSION The use of high doses of botulinum toxin increases progressively, but must remain very careful.
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Affiliation(s)
- M Rousseaux
- Service de rééducation neurologique, Hôpital Swynghedauw, CHU, 59037 Lille cedex, France.
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Esquenazi A. Improvements in healthcare and cost benefits associated with botulinum toxin treatment of spasticity and muscle overactivity. Eur J Neurol 2006; 13 Suppl 4:27-34. [PMID: 17112347 DOI: 10.1111/j.1468-1331.2006.01651.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spasticity is a widespread, disabling form of muscle overactivity affecting patients with central nervous system damage resulting in upper motor neurone syndrome. There is a range of effective therapies for the treatment of spasticity (e.g. physical, anaesthetic, chemodenervation and neurolytic injections, systemic medication and surgery), but all therapies must be based on an individualized, multidisciplinary programme targeted to achieve patient goals. Appropriate therapy should be based on the extent and severity of spasticity, but spasticity and its consequences, regardless of presentation or cause, are commonly treated with systemic agents. This may be ill-advised as systemic treatment is associated with many undesirable effects. In particular, elderly patients with post-stroke spasticity are at risk from the central adverse effects of systemic medication (e.g. sedation and gait disturbance), which make them more susceptible to falling, with an associated increased risk of fracture. The rising costs of fracture care and its sequelae are fast becoming an international problem contributing to high healthcare expenditure. Botulinum toxin type-A (BoNT-A) treatment is highly effective for some of the more common forms of spasticity and muscle overactivity, and has a favourable profile when compared with systemic agents and other focal treatments. Therefore, the clinical benefits of BoNT-A treatment outweigh the apparent high costs of this intervention, showing it to be a cost-effective treatment.
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Affiliation(s)
- A Esquenazi
- Department of Physical Medicine and Rehabilitation, Gait and Motion Analysis Laboratory, MossRehab and Albert Einstein Medical Centre, Elkins Park, PA 19027, USA.
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Heinen F, Molenaers G, Fairhurst C, Carr LJ, Desloovere K, Chaleat Valayer E, Morel E, Papavassiliou AS, Tedroff K, Ignacio Pascual-Pascual S, Bernert G, Berweck S, Di Rosa G, Kolanowski E, Krägeloh-Mann I. European consensus table 2006 on botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2006; 10:215-25. [PMID: 17097905 DOI: 10.1016/j.ejpn.2006.08.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 08/22/2006] [Indexed: 10/23/2022]
Abstract
An interdisciplinary group of experienced botulinum toxin users and experts in the field of movement disorders was assembled, to develop a consensus on best practice for the treatment of cerebral palsy using a problem-orientated approach to integrate theories and methods. The authors tabulated the supporting evidence to produce a condensed but comprehensive information base, pooling data and experience from nine European countries, 13 institutions and more than 5500 patients. The consensus table summarises the current understanding regarding botulinum toxin treatment options in children with CP.
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Affiliation(s)
- Florian Heinen
- Department of Paediatric Neurology and Developmental Neurology, Dr. von Hauner's Children's Hospital, University of Munich, Lindwurmstr. 4, D-80337 Munich, Germany.
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Ward A, Roberts G, Warner J, Gillard S. Cost-effectiveness of botulinum toxin type a in the treatment of post-stroke spasticity. J Rehabil Med 2005; 37:252-7. [PMID: 16024483 DOI: 10.1080/16501970510027312] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Treatment strategies for post-stroke spasticity include oral anti-spastic drugs, surgery, physiotherapy and botulinum toxin type A injection. The objective of this study was to compare the cost-effectiveness and outcomes of oral therapy vs. botulinum toxin type A treatment strategies in patients with flexed wrist/clenched fist spasticity. METHODS Treatment outcome and resource use data were collected from an expert panel experienced in the treatment of post-stroke spasticity. A decision tree model was developed to analyse the data. RESULTS Thirty-five percent of patients receiving oral therapy showed an improvement in pre-treatment functional targets which would warrant continuation of therapy, compared with 73% and 68% of patients treated with botulinum toxin type A first- and second-line therapy, respectively. Botulinum toxin type A treatment was also more cost-effective than oral therapy with the "cost-per-successfully-treated month" being 942 pounds, 1387 pounds and 1697 pounds for botulinum toxin type A first-line, botulinum toxin type A second-line and oral therapy, respectively. CONCLUSION In conclusion, botulinum toxin type A is a cost-effective treatment for post-stroke spasticity.
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Affiliation(s)
- Anthony Ward
- North Staffordshire Rehabilitation Unit, The Hayward, Stoke-on-Trent, Staffordshire, UK
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Affiliation(s)
- P Prithvi Raj
- World Institute of Pain, Section of Pain Practice, Antioch, California, USA.
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