High doses of a new botulinum toxin type A (NT-201) in adult patients with severe spasticity following brain injury and cerebral palsy.
BACKGROUND
Spasticity can be a severe disabling disorder requiring high-dose injections of botulinum toxin type A (BoNT-A). Efficacy and safety of high BoNT-A doses in reducing multi-level spasticity of subjects with brain injury and cerebral palsy were investigated. Pain and functional outcome were also assessed.


METHODS
High doses (up to 840 IU) of incobotulinumtoxinA were injected in adult subjects with severe spasticity of the upper and lower limbs due to brain injury (BI) and cerebral palsy (CP). The Modified Ashworth Scale, Visual Analogue scale, Glasgow Outcome Scale, Franchay Arm Test (FAT) and Barthel Scale were employed to assess spasticity, pain and functional outcome at baseline, and 4 and 16 weeks after BoNT-A injection.


RESULTS
Twenty-two (12 M, 10 F; mean age 38.1 ± 13.7 years) subjects - 16 subjects with BI and 6 with CP - were enrolled. Elbow, wrist, fingers and ankle muscles showed significant spasticity reduction after BoNT-A injections. The mean FAT score improved, but the benefit was not significant. Three (13.6%) subjects complained of mild adverse events.


CONCLUSIONS
High-dose BoNT-A injections were effective and safe in reducing spasticity of BI and CP subjects. A significant reduction of the pain was also observed, but global functionality and arm dexterity were unchanged.
Neuro-Rehabilitation Unit, Scientific Institute, Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy.
Domenico
D
Intiso
Neuro-Rehabilitation Unit, Scientific Institute, Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy Foundation rehabilitation "Gli Angeli di P.Pio", San Giovanni Rotondo (Foggia), Italy.
Valentina
V
Simone
Neuro-Rehabilitation Unit, Scientific Institute, Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy.
Filomena
F
Di Rienzo
Neuro-Rehabilitation Unit, Scientific Institute, Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy.
Andrea
A
Iarossi
Neuro-Rehabilitation Unit, Scientific Institute, Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy.
Luigi
L
Pazienza
Department of Physical Medicine and Rehabilitation, "OORR Hospital", University of Foggia, Foggia, Italy.
Andrea
A
Santamato
Neuro-Rehabilitation Unit, Scientific Institute, Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy.
Giuseppe
G
Maruzzi
Neuro-Rehabilitation Unit, Scientific Institute, Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (Foggia), Italy.
Mario
M
Basciani
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001132:Arm; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D001930:Brain Injuries / Q000150:complications*; D002547:Cerebral Palsy / Q000150:complications*; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C545476:incobotulinumtoxinA
Botulinum toxin; brain injury; cerebral palsy; efficacy; high dose; spasticity