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Using Botulinum Toxin (BoNT) to Manage Spasticity in Older Adults | Drug News | Mar 2020

March 2020 | Drug Information and News for Health Care Providers | View PDF

What is spasticity, and how prevalent is it?
Spasticity may be described as a disruption in sensorimotor control that results in involuntary activation of muscles.1,2 It may occur as a result of stroke, traumatic brain injury, spinal cord injury, and multiple sclerosis. It can cause stiffness, pain, involuntary movements, reduced mobility, and increase in care requirements.1,2 The prevalence of spasticity in residents in long-term care homes has been reported to be 21% to 35%.3

Treatment of Spasticity
Botulinum toxin (BoNT) is the most widely used treatment for focal spasticity and has been shown to have better tolerance and efficacy than oral treatments.4

References for table: 5–7

Duration of effect:5–7
BoNT takes 10–14 days to have a visible effect. The effects last for 3–4 months and are reversible as the toxin begins to degrade. May repeat therapy at intervals ≥ 3 months.

Adverse effects:5–7
Dysphagia due to possible dissemination of BoNT to other areas of the body. Other transient adverse effects include injection site reactions, dry mouth, and upper respiratory tract infections.


References:
1. Nair KPS, Marsden J. The management of spasticity in adults. BMJ 2014;349:g4737. Doi: 10.1136/bmj.g4737.
2. Graham LA. Management of spasticity revisited. Age Aging 2013;42:435-441.
3. Sayce L, Hudson T, Heusinkveld L, et al. Spasticity diagnosis and treatment in the United States – a priority for our aging population. Int J Neurorehabilitation 2016;3(3):1-3. Doi: 10.4172/2376-0281.100021.
4. Chang E, Ghosh N, Yanni D, Lee S, Alexandru D, Mozaffar T. A Review of Spasticity Treatments: Pharmacological and Interventional Approaches. Critical Reviews in Physical and Rehabilitation Medicine 2013;25(1-2):11–22. Doi:10.1615/ CritRevPhysRehabilMed.2013007945.
5. Botox product monograph. 2018. Allergan.
6. Dysport Aesthetic product monograph. 2018. Ipsen Biopharm Ltd.
7. Xeomin product monograph. 2018. Merz Pharmaceuticals GmbH.

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