title: Early physiotherapy after injection of botulinum toxin increases the beneficial effects on spasticity in patients with multiple sclerosis.
abstract: OBJECTIVE
  To determine whether additional physiotherapy increases botulinum toxin type A effects in reducing spasticity in patients with multiple sclerosis.
  
  
  METHODS
  A single-blind, randomized, controlled pilot trial with a 12-week study period.
  
  
  METHODS
  Thirty-eight patients with progressive multiple sclerosis affected by focal spasticity and who were observed at the Multiple Sclerosis Centre operating in the S. Andrea Hospital in Rome.
  
  
  METHODS
  For intervention all patients received botulinum toxin type A; the treatment group also received additional physiotherapy to optimize management through passive or active exercise and stretching regimens.
  
  
  METHODS
  To measure objective and subjective level of spasticity, patients were assessed at baseline, 2, 4 and 12 weeks post treatment by Modified Ashworth Scale and visual analogue scale.
  
  
  RESULTS
  When compared with the control group, we found a significant decrease of spasticity by Modified Ashworth Scale (P < 0.01 by t-test) in the treatment group at week 2 (2.73 versus 3.22), week 4 (2.64 versus 3.33) and week 12 (2.68 versus 3.33). The mean (%) difference in Modified Ashworth Scale score between baseline and the end of follow-up was -0.95 (26.1) in the treatment group and -0.28 (7.7) in the control group (P < 0.01). The combined treatment proved also to be more effective by visual analogue scale (P < 0.01) at week 4 (6.95 versus 5.50) and at week 12 (7.86 versus 6.56) but not at week 2 (5.18 versus 5.50; P = 0.41).
  
  
  CONCLUSIONS
  Our data suggest that physiotherapy in combination with botulinum toxin type A injection can improve overall response to botulinum toxin.
authors.affiliation: Multiple Sclerosis Centre, S. Andrea Hospital, University of Rome La Sapienza, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Giovannelli
authors.forename: G
authors.initials: G
authors.lastname: Borriello
authors.forename: P
authors.initials: P
authors.lastname: Castri
authors.forename: L
authors.initials: L
authors.lastname: Prosperini
authors.forename: C
authors.initials: C
authors.lastname: Pozzilli
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000628:therapy*; D009128:Muscle Spasticity / Q000628:therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D016037:Single-Blind Method
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A