Onabotulinum toxin A may have a role in treating lower extremity spasticity and aiding walking in patients with MS, researchers report.
SAN ANTONIO—Onabotulinum toxin A (Botox) may help improve ambulation in patients with multiple sclerosis (MS), according to research presented at the 24th Annual Meeting of the Consortium of Multiple Sclerosis Centers.
“We observed improvements in ambulation speed, endurance, ambulation on uneven surfaces, and in the ability to ascend and descend inclines and stairs,” reported Christine Short, MD. “Overall improvements in total ambulation capability occurred. Subjectively, individuals also reported improved clonus, decreased tone, decreased pain, decreased muscle spasm, and greater ease of ambulation.” Dr. Short is an Assistant Professor, Division of Physical Medicine, Rehabilitation, and Neurosurgery, Dalhousie University in Halifax, Nova Scotia, Canada.
The findings are based on a case series of five patients with MS whose walking abilities had been compromised by spasticity in the lower extremities. Each participant had problems with extensor and inversion spasticity in one or both lower extremities at the time of treatment. The patients also complained of catching their toes during ambulation, which led to tripping and falling, painful muscle spasms, clonus, and spasticity that interfered with sleep.
All patients participated in physical therapy and were treated with oral antispasticity agents. “In each case, focal neurolysis with Botox was considered when, clinically, there was a suboptimal response to oral and physical therapies or if the therapies were not tolerated due to side effects,” Dr. Short noted.
The total dosage of Botox for each patient ranged from 200 units to 400 units. The investigators measured ambulation speed and endurance before Botox therapy and six weeks after the therapy, “when Botox would be having a maximal effect,” Dr. Short stated. Speed and endurance were determined with use of the six-minute walk test.
“All the individuals treated showed improvements in ambulation speed,” reported Dr. Short. “All subjects also showed improvements in ambulation endurance. Some of the improvements were greater than twofold above baseline. Subjectively, individuals also described improvements in other areas, including decreased pain and decreased clonus, decreased muscle spasms, and greater ease of ambulation in all five cases. Clinically, we observed decreased spasticity in the treated muscles and improved gait."
Dr. Short pointed out that the small sample size of patients did not allow for a more rigorous statistical analysis. “However,” she concluded, “our very interesting observations suggest that further research would be valuable to assess the usefulness of Botox as a treatment for improving ambulation in persons with MS and lower extremity spasticity.
—Rebecca K. Abma