Management of Spasticity Caused by Thrombotic Brain Injury with Incobotulinumtoxina in a Young Patient: A New Paradigm

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Paba Dotes Ana Belen De Torres-Garcia Irene

Abstract

Case: Acquired brain damage is one of the most complex pathologies that affect the central nervous system, there is great variability in its pathophysiology, from traumatic focal injuries to diffuse axonal injuries, including spasticity. It supposes a great comorbidity and functional repercussion in patients, hindering their subsequent recovery. We report a case of a young patient with a history of quadriplegia due to acquired brain damage secondary to thrombosis of the dural sinus. The patient presented sensorimotor deficit, restricted function, and a great situation of dependency. He required three cycles of high doses of incobotulinumtoxinA (IncoBoNT) according to his specific need, the first infiltration was 800 U, the second 800 U, and the last 500 U over a period of 14 weeks. Thanks to the previous objectives agreement with the patient the results were satisfactory and relevant for him, presenting a great functional improvement of spasticity and associated pain, as assessed by the visual analog scale score.Conclusion: IncoBoNT at high doses and short intervals has been shown to be an effective and valuable tool for personalized treatment adapted to the needs of severely affected neurological patients.

Keywords: High doses, Short interval, incobotulinumtoxin A

Article Details

How to Cite
ANA BELEN, Paba Dotes; IRENE, De Torres-Garcia. Management of Spasticity Caused by Thrombotic Brain Injury with Incobotulinumtoxina in a Young Patient: A New Paradigm. Medical Research Archives, [S.l.], v. 10, n. 6, june 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2836>. Date accessed: 21 nov. 2024. doi: https://doi.org/10.18103/mra.v10i6.2836.
Section
Case Reports

References

1. McGinn MJ, Povlishock JT. Pathophysiology of Traumatic Brain Injury. Neurosurg Clin N Am. 2016;27(4):397-407. doi:10.1016/j.nec.2016.06.002
2. Sepúlveda P, Bacco JL, Cubillos A, Doussoulin A. Espasticidad como signo positivo de daño de motoneurona superior y su importancia en rehabilitación. Ces Med. 2018;32(3):259-269. doi:10.21615/cesmedicina.32.3.7
3. López De Munain L, Valls-Solé J, Garcia Pascual I, Maisonobe P. Botulinum Toxin Type A Improves Function According to Goal Attainment in Adults with Poststroke Lower Limb Spasticity in Real Life Practice. Eur Neurol. 2019. doi:10.1159/000503172
4. Li J, Zhang R, Cui BL, et al. Therapeutic efficacy and safety of various botulinum toxin a doses and concentrations in spastic foot after stroke: A randomized controlled trial. Neural Regen Res. 2017;12(9):1451-1457. doi:10.4103/1673-5374.215257
5. Frevert J. Content of botulinum neurotoxin in botox®vistabel ®, dysport®azzalure®, and xeomin®bocouture. Drugs R D. 2010;10(2):67-73. doi:10.2165/11584780-000000000-00000
6. Ianieri G, Marvulli R, Gallo GA, Fiore P, Megna M. “Appropriate treatment” and therapeutic window in spasticity treatment with IncobotulinumtoxinA: From 100 to 1000 units. Toxins (Basel). 2018;10(4). doi:10.3390/toxins10040140
7. Dressler D, Adib Saberi F, Kollewe K, Schrader C. Safety aspects of incobotulinumtoxinA high-dose therapy. J Neural Transm. 2015;122(2):327-333. doi:10.1007/s00702-014-1252-9
8. Santamato A, Panza F, Intiso D, et al. Long-term safety of repeated high doses of incobotulinumtoxinA injections for the treatment of upper and lower limb spasticity after stroke. J Neurol Sci. 2017;378:182-186. doi:10.1016/j.jns.2017.04.052
9. Intiso D, Simone V, Bartolo M, et al. High dosage of botulinum toxin type a in adult subjects with spasticity following acquired central nervous system damage: Where are we at? Toxins (Basel). 2020;12(5):1-18. doi:10.3390/toxins12050315
10. Wissel J, Bensmail D, Ferreira JJ, et al. Safety and efficacy of incobotulinumtoxinA doses up to 800 U in limb spasticity the TOWER study. Neurology. 2017;88(14):1321-1328. doi:10.1212/WNL.0000000000003789
11. Santamato A, Micello MF, Panza F, et al. Can botulinum toxin type A injection technique influence the clinical outcome of patients with post-stroke upper limb spasticity? A randomized controlled trial comparing manual needle placement and ultrasound-guided injection techniques. J Neurol Sci. 2014;347(1-2):39-43. doi:10.1016/j.jns.2014.09.016
12. Simpson DM, Hallett M, Ashman EJ, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016;86(19):1818-1826. doi:10.1212/WNL.0000000000002560
13. Ro T, Ota T, Saito T, Oikawa O. Spasticity and Range of Motion Over Time in Stroke Patients Who Received Multiple-Dose Botulinum Toxin Therapy. J Stroke Cerebrovasc Dis. 2020;29(1). doi:10.1016/j.jstrokecerebrovasdis.2019.104481
14. Matak I, Bölcskei K, Bach-Rojecky L, Helyes Z. Mechanisms of botulinum toxin type A action on pain. Toxins (Basel). 2019;11(8):1-24. doi:10.3390/toxins11080459
15. Bakheit AMO, Liptrot A, Newton R, Pickett AM. The effect of total cumulative dose, number of treatment cycles, interval between injections, and length of treatment on the frequency of occurrence of antibodies to botulinum toxin type A in the treatment of muscle spasticity. Int J Rehabil Res. 2012;35(1):36-39. doi:10.1097/MRR.0b013e32834df64f
16. Picelli MD, PhD A, Baricich MD A, Cisari MD C, Paolucci MD S, Smania MD N, Sandrini MD G. The Italian real-life post-stroke spasticity survey: unmet needs in the management of spasticity with botulinum toxin type A. Funct Neurol. 2017;32(2):89-96. https://www.proquest.com/docview/1926896072?accountid=48149.