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High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at?

1
Unit of Neuro-Rehabilitation Unit and Rehabilitation Medicine, IRCCS ‘Casa Sollievo della Sofferenza’, Viale dei Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy
2
Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Zingonia, Ciserano, 24040 Bergamo, Italy
3
Department of Physical Medicine and Rehabilitation, OO.RR Hospital, University of Foggia, 71122 Foggia, Italy
*
Author to whom correspondence should be addressed.
Toxins 2020, 12(5), 315; https://doi.org/10.3390/toxins12050315
Received: 15 April 2020 / Revised: 28 April 2020 / Accepted: 7 May 2020 / Published: 10 May 2020
Spasticity is a common disabling disorder in adult subjects suffering from stroke, brain injury, multiple sclerosis (MS) and spinal cord injury (SCI). Spasticity may be a disabling symptom in people during rehabilitation and botulinum toxin type A (BTX-A) has become the first-line therapy for the local form. High BTX-A doses are often used in clinical practice. Advantages and limitations are debated and the evidence is unclear. Therefore, we analysed the efficacy, safety and evidence for BTX-A high doses. Studies published from January 1989 to February 2020 were retrieved from MEDLINE/PubMed, Embase, Cochrane Central Register. Only obabotulinumtoxinA (obaBTX-A), onabotulinumtoxinA (onaBTX-A), and incobotulinumtoxinA (incoBTX-A) were considered. The term “high dosage” indicated ≥ 600 U. Thirteen studies met the inclusion criteria. Studies had variable method designs, sample sizes and aims, with only two randomised controlled trials. IncoBTX-A and onaBTX-A were injected in three and eight studies, respectively. BTX-A high doses were used predominantly in treating post-stroke spasticity. No studies were retrieved regarding treating spasticity in MS and SCI. Dosage of BTX-A up to 840 U resulted efficacious and safety without no serious adverse events (AEs). Evidence is insufficient to recommend high BTX-A use in clinical practice, but in selected patients, the benefits of high dose BTX-A may be clinically acceptable. View Full-Text
Keywords: botulinum toxin; spasticity; high doses; rehabilitation botulinum toxin; spasticity; high doses; rehabilitation
MDPI and ACS Style

Intiso, D.; Simone, V.; Bartolo, M.; Santamato, A.; Ranieri, M.; Gatta, M.T.; Di Rienzo, F. High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at? Toxins 2020, 12, 315. https://doi.org/10.3390/toxins12050315

AMA Style

Intiso D, Simone V, Bartolo M, Santamato A, Ranieri M, Gatta MT, Di Rienzo F. High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at? Toxins. 2020; 12(5):315. https://doi.org/10.3390/toxins12050315

Chicago/Turabian Style

Intiso, Domenico; Simone, Valentina; Bartolo, Michelangelo; Santamato, Andrea; Ranieri, Maurizio; Gatta, Maria T.; Di Rienzo, Filomena. 2020. "High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at?" Toxins 12, no. 5: 315. https://doi.org/10.3390/toxins12050315

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