[Early pain reduction in the treatment of spasticity after a single injection of botulinum A toxin].
HISTORY, ADMISSION FINDINGS AND DIAGNOSIS: After stem-cell transplantation a 45-year-old woman (case 1) had an attack of general hypoxia requiring resuscitation. She then developed a quadriplegia and spasticity of all limbs notably of the right arm and a severe pain syndrome which had to be treated by oral and intravenous analgesics. Immobilisation and secondary complications aggravated the already difficult situation. In the 2nd case a 66-year-old woman was admitted to our outpatient clinic with long-standing left-sided spastic hemiparesis after territorial infarction of the right middle cerebral artery. Beside the spasticity she also suffered from a distinct pain syndrome which did not respond to any oral analgesics.


METHODS
For the treatment of the main symptoms, both patients received intramuscular injections of 1000 MU botulinum toxin A (Dysport(R) Ipsen Pharma). Astonishingly, both patients experienced pain relief the next day, whereas spasticity started to respond only 5-6 days later.


CONCLUSIONS
In our experience pain relief after botulinum toxin A injections occurs not only due to reduced muscle hyperactivity, especially when such a temporal dissociation between pain relief and muscle relaxation appears as in the two cases reported above. Rather, we believe that botulinum toxin A interferes with the release of other neurotransmitters e. g. substance P (SP) and calcitonine-gene-related-peptide (CGRP) having a key function in the nociceptive cascade.
Chalkiadaki
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A
Neurologische Klinik, Heinrich-Heine-Universität, Düsseldorf. chalkiadaki@med.uni-duesseldorf.de
Rohr
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UP
Hefter
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H
D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007273:Injections, Intramuscular; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018377:Neurotransmitter Agents / Q000037:antagonists & inhibitors*; D010146:Pain / Q000188:drug therapy*; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D018377:Neurotransmitter Agents; D019274:Botulinum Toxins, Type A