title: Botulinum neurotoxin type A injections reduce spasticity in mild to moderate hereditary spastic paraplegia--report of 19 cases.
abstract: Hereditary spastic paraplegia (HSP) is characterized by lower extremity spasticity. Symptomatic therapy generally includes physical therapy and oral antispastic agents, in selected cases intrathecal baclofen. Because of the positive results in other treatments of spasticity, the use of botulinum neurotoxin type A (BoNT-A) might also be considered for patients with HSP. We report the effect of BoNT-A injections in 19 unselected patients with HSP treated by the members of the German Spasticity Education Group. In 17 patients, the modified Ashworth scale had improved by one point. In one patient, it improved by three points. Most of the patients reported reduction of spasticity. BoNT-A injections were continued in 11 of 19 patients (57.9%). All of the patients with continued injections had a good or very good global subjective improvement. Patients with less pronounced spasticity and patients with accompanying physical therapy tended to exhibit a better effect. Only four patients reported adverse effects which were increased weakness in three patients and pain in one patient. BoNT-A injections appear to reduce spasticity effectively and safely, especially in patients with mild to moderate spasticity. The preliminary results of our case series should encourage larger studies of BoNT-A injections in HSP.
authors.affiliation: Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany. martin.hecht@bkh-kaufbeuren.de
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Hecht
authors.forename: Henning
authors.initials: H
authors.lastname: Stolze
authors.forename: Matthias
authors.initials: M
authors.lastname: Auf dem Brinke
authors.forename: Ralf
authors.initials: R
authors.lastname: Giess
authors.forename: Thoams
authors.initials: T
authors.lastname: Treig
authors.forename: Martin
authors.initials: M
authors.lastname: Winterholler
authors.forename: Jörg
authors.initials: J
authors.lastname: Wissel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D015419:Spastic Paraplegia, Hereditary / Q000150:complications / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A