title: Does giving segmental muscle vibration alter the response to botulinum toxin injections in the treatment of spasticity in people with multiple sclerosis? A single-blind randomized controlled trial.
abstract: OBJECTIVE
  To determine if segmental muscle vibration and botulinum toxin-A injection, either alone or in combination, reduces spasticity in a sample of patients with multiple sclerosis.
  
  
  METHODS
  Single-blind, randomized controlled trial.
  
  
  METHODS
  Physical medicine and rehabilitation outpatients service.
  
  
  METHODS
  Forty-two patients affected by the secondary progressive form of multiple sclerosis randomized to group A (30 minutes of 120 Hz segmental muscle vibration over the rectus femoris and gastrocnemius medial and lateral, three per week, over a period of four weeks), group B (botulinum toxin in the rectus femoris, gastrocnemius medial and lateral and soleus, and segmental muscle vibration) and group C (botulinum toxin).
  
  
  METHODS
  Modified Ashworth Scale at knee and ankle, and Fatigue Severity Scale. All the measurements were performed at baseline (T0), 10 weeks (T1) and 22 weeks (T2) postallocation.
  
  
  RESULTS
  Modified Ashworth Scale at knee and ankle significantly decreased over time (p < 0.001) in all groups. Patients in group C displayed a significant increase of knee and ankle spasticity at T2 when compared with T1 (p < 0.05). Fatigue Severity Scale values in groups A and C were significantly higher at T0 [A: 53.6 (2.31); C: 48.5 (2.77)] than at either T1 [A: 48.6 (2.21); p = 0.03; C: 43.5 (3.22); p = 0.03] or T2 [A: 46.7 (2.75); p = 0.02; 42.5 (2.17); p = 0.02], while no differences were detected in group B [T0: 43.4 (3.10); T1: 37.3 (3.15); T2: 39.7 (2.97)].
  
  
  CONCLUSIONS
  Segmental muscle vibration and botulinum toxin-A reduces spasticity and improves fatigue in the medium-term follow-up in patients with multiple sclerosis.
authors.affiliation: Physical Medicine and Rehabilitation, Sapienza - University of Rome, Rome, Italy. marco.paoloni@uniroma1.it
authors.forename: Marco
authors.initials: M
authors.lastname: Paoloni
authors.forename: Morena
authors.initials: M
authors.lastname: Giovannelli
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mangone
authors.forename: Laura
authors.initials: L
authors.lastname: Leonardi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Tavernese
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Di Pangrazio
authors.forename: Andrea
authors.initials: A
authors.lastname: Bernetti
authors.forename: Valter
authors.initials: V
authors.lastname: Santilli
authors.forename: Carlo
authors.initials: C
authors.lastname: Pozzilli
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004185:Disability Evaluation; D005221:Fatigue / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D016037:Single-Blind Method; D014732:Vibration / Q000627:therapeutic use*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Multiple sclerosis; botulinum toxin; fatigue; spasticity; vibration