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OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity

1
Neurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
2
Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
3
IRCCS Neuromed, 86077 Pozzilli, IS, Italy
4
Department of Neurophysiopathology, IRCCS Mondino Foundation, 27100 Pavia, Italy
5
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
6
Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00100 Rome, Italy
*
Author to whom correspondence should be addressed.
Toxins 2019, 11(6), 359; https://doi.org/10.3390/toxins11060359
Received: 5 May 2019 / Revised: 20 May 2019 / Accepted: 18 June 2019 / Published: 20 June 2019
(This article belongs to the Special Issue Botulinum Toxin for Neuropathic Pain Treatment)
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Abstract

Spasticity is a muscle tone disorder associated with different neurological conditions. Spasticity could be associated with pain, high disability, poor functional recovery, and reduced quality of life. Botulinum neurotoxin type A (BoNT-A) is considered a first-line treatment for spasticity and, more recently, it also represents a therapeutic option for various chronic pain conditions. In this open label study, we aim to evaluate the effect of the BoNT-A on the spinal nociception in patients affected by spasticity of the lower limbs with associated pain with predominantly neuropathic features. Ten patients with stroke, 10 with multiple sclerosis and 5 with spinal cord injury were enrolled in the study. They were tested with clinical scales (neuropathic pain scale inventory (NPSI), numerical rating scale (NRS), modified Ashworth scale (MAS) and with the nociceptive withdrawal reflex at lower limbs to explore the spinal temporal summation threshold at baseline and 30 day after BoNT-A injection. OnabotulinumtoxinA (50 to 200 units per site) was injected in the lower limb muscles according to the distribution of spasticity. No significant differences were found at baseline for neurophysiological features across groups. After the BoNT-A injection, we recorded a significant reduction in MAS and NRS scores. Regarding the neurophysiological parameters, we described a significant increase in the temporal summation threshold after the BoNT-A injection. Our data supports the hypothesis that peripherally injected OnabotulinumtoxinA modulates the excitability of spinal cord nociceptive pathways. This activity may take place irrespective of the effect of the drug on spasticity. View Full-Text
Keywords: botulinum toxin; spasticity; neuropathic pain; lower limb reflex; spinal temporal summation; stroke; multiple sclerosis; spinal cord injury botulinum toxin; spasticity; neuropathic pain; lower limb reflex; spinal temporal summation; stroke; multiple sclerosis; spinal cord injury
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De Icco, R.; Perrotta, A.; Berra, E.; Allena, M.; Alfonsi, E.; Tamburin, S.; Serrao, M.; Sandrini, G.; Tassorelli, C. OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity. Toxins 2019, 11, 359.

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