Spasticity, Brain Injuries, Spinal Cord Injuries, Multiple Sclerosis
Conditions
Brief summary
Spasticity has been defined as a disorder of the sensorimotor system characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex. The treatment goal of spasticity is Medical treatment generally combines physiotherapy with medications, depending on spasticity distribution. Systemic treatments such as oral or intrathecal baclofen are generally considered in case of generalized spasticity, whereas local treatments are considered in case of focal spasticity. Local treatments such as Botulinum Toxin type A, phenol, and alcohol present several advantages, allowing to treat of selected muscles without the risk of sedation. As stated above, they are indicated for focal spasticity but might be helpful even in the presence of generalized spasticity with identified focal goals (Bethoux et al., 2015). In particular, Botulinum Toxin type A (BoNT-A) is considered the gold standard treatment for focal spasticity, showing a level A evidence for spasticity reduction in upper- and lower-limb spasticity (Simpson et al., 2016). However, current evidence is mainly focused on post-stroke spasticity (Franceschini et al., 2014), whereas it is still limited in spasticity as a consequence of other aetiologies, such as spinal cord injury (SCI), traumatic brain injury (TBI), or multiple sclerosis (MS). Interestingly, spasticity is a major concern for the rehabilitation of these patients. The aim of this observational study is the evaluation of the clinical efficacy of BoNT-A in spasticity reduction in patients affected by neurological conditions different from post-stroke spasticity, such as SCI, TBI, and MS.
Interventions
Adult patients with spasticity due to traumatic brain injury, spinal cord injury, or MS, treated with Botulinum Toxin type A. As this is a non-interventional study, no diagnostic, therapeutic, or experimental intervention is involved. Subjects will receive clinical assessments, medications, and treatments solely as determined by their study physician.
Sponsors
Ipsen
Azienda Ospedaliero Universitaria Maggiore della Carita
SIRN
Università degli Studi del Piemonte Orientale Amedeo Avogadro
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \>18 years * Spasticity as a consequence of traumatic brain injury, spinal cord injury or MS (documented by clinical records) * Muscle tone graded at least 1+ on the modified Ashworth scale in the relevant joints of the affected limb(s), which requires medical intervention * BoNT naïve or pre-treated with any BoNT product. If previously treated with any BoNT, at least a 4 months interval between last injection and inclusion
Exclusion criteria
* Presence of fixed contractures or bony deformities in the affected limb * Changes in any oral antispastic medications or specific physiotherapy regimen \<4m before study entry or during the study. * Other neurological or orthopaedic conditions involving the affected limbs. * Sensitivity to BoNT-A or to its excipients * Other contraindications as given in the local SmPC for BoNT-A
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Modified Ashworth Scale (MAS) | 1 month | Percentage of patients with at least 1 point reduction of MAS in any treated muscle, 1 month after BoNT-A injection injection of Botulinum toxin A (responders) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| active range of motion | e, 1, 3 and 6 months or before new BoNT-A injection | Documentation of active range of motion (a-ROM) for the treated joints in the overall study population at baseline, 1, 3 and 6 months or before new BoNT-A injection using a handheld goniometer. |
| passive range of motion | e, 1, 3 and 6 months or before new BoNT-A injection | Documentation of passive range of motion (p-ROM) for the treated joints in the overall study population at baseline, 1, 3 and 6 months or before new BoNT-A injection using a handheld goniometer. |
| Global Assessment of Efficacy scale) | 1 month and 3 months after boNT-A injection | Evaluation of treatment goal achievement by the physicians, patients and caregivers at 1 and 3 months after BoNT-A injection |
| EQ5-D | 1, 3 and 6 months after BoNT-A or before the new BoNT-A injection | Quality of life will be assessed in the overall study population at baseline, 1, 3 and 6 months after BoNT-A or before the new BoNT-A injection using EQ5-D questionnaire. |
| interval of time between BoNT-A reinjections | 3-6 months | Documentation of the interval of time between reinjections will be assessed during 6-months follow up (if applicable) |
| Numeric Rating Scale for pain | , 1, 3 and 6 months after BoNT-A or before the new BoNT-A injection | Pain will be assessed in the overall study population at baseline, 1, 3 and 6 months after BoNT-A or before the new BoNT-A injection using Numeric Rating Scale (pain). |
Countries
Italy
Contacts
Primary ContactAlessio Baricich
Backup ContactRoberta Carozzi
Outcome results
None listed