PMID- 32397674
OWN - NLM
STAT- MEDLINE
DCOM- 20210304
LR  - 20210304
IS  - 2072-6651 (Electronic)
IS  - 2072-6651 (Linking)
VI  - 12
IP  - 5
DP  - 2020 May 10
TI  - High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following 
      Acquired Central Nervous System Damage: Where Are We at?
LID - 10.3390/toxins12050315 [doi]
LID - 315
AB  - 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.
FAU - Intiso, Domenico
AU  - Intiso D
AD  - Unit of Neuro-Rehabilitation Unit and Rehabilitation Medicine, IRCCS 'Casa 
      Sollievo della Sofferenza', Viale dei Cappuccini 1, San Giovanni Rotondo, 71013 
      Foggia, Italy.
FAU - Simone, Valentina
AU  - Simone V
AD  - Unit of Neuro-Rehabilitation Unit and Rehabilitation Medicine, IRCCS 'Casa 
      Sollievo della Sofferenza', Viale dei Cappuccini 1, San Giovanni Rotondo, 71013 
      Foggia, Italy.
FAU - Bartolo, Michelangelo
AU  - Bartolo M
AD  - Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Zingonia, 
      Ciserano, 24040 Bergamo, Italy.
FAU - Santamato, Andrea
AU  - Santamato A
AD  - Department of Physical Medicine and Rehabilitation, OO.RR Hospital, University of 
      Foggia, 71122 Foggia, Italy.
FAU - Ranieri, Maurizio
AU  - Ranieri M
AD  - Department of Physical Medicine and Rehabilitation, OO.RR Hospital, University of 
      Foggia, 71122 Foggia, Italy.
FAU - Gatta, Maria Teresa
AU  - Gatta MT
AD  - Unit of Neuro-Rehabilitation Unit and Rehabilitation Medicine, IRCCS 'Casa 
      Sollievo della Sofferenza', Viale dei Cappuccini 1, San Giovanni Rotondo, 71013 
      Foggia, Italy.
FAU - Di Rienzo, Filomena
AU  - Di Rienzo F
AD  - Unit of Neuro-Rehabilitation Unit and Rehabilitation Medicine, IRCCS 'Casa 
      Sollievo della Sofferenza', Viale dei Cappuccini 1, San Giovanni Rotondo, 71013 
      Foggia, Italy.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20200510
PL  - Switzerland
TA  - Toxins (Basel)
JT  - Toxins
JID - 101530765
RN  - 0 (Acetylcholine Release Inhibitors)
RN  - 0 (Neuromuscular Agents)
RN  - EC 3.4.24.69 (Botulinum Toxins, Type A)
RN  - EC 3.4.24.69 (incobotulinumtoxinA)
RN  - EC 3.4.24.69 (onabotulinum toxin A)
SB  - IM
MH  - Acetylcholine Release Inhibitors/*administration & dosage/adverse effects
MH  - Adult
MH  - Aged
MH  - Botulinum Toxins, Type A/*administration & dosage/adverse effects
MH  - Central Nervous System Diseases/*complications/physiopathology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Muscle Spasticity/*drug therapy/etiology/physiopathology
MH  - Neuromuscular Agents/*administration & dosage/adverse effects
MH  - Treatment Outcome
PMC - PMC7291232
OTO - NOTNLM
OT  - botulinum toxin
OT  - high doses
OT  - rehabilitation
OT  - spasticity
COIS- The authors declare no conflict of interest.
EDAT- 2020/05/14 06:00
MHDA- 2021/03/05 06:00
PMCR- 2020/05/01
CRDT- 2020/05/14 06:00
PHST- 2020/04/15 00:00 [received]
PHST- 2020/04/28 00:00 [revised]
PHST- 2020/05/07 00:00 [accepted]
PHST- 2020/05/14 06:00 [entrez]
PHST- 2020/05/14 06:00 [pubmed]
PHST- 2021/03/05 06:00 [medline]
PHST- 2020/05/01 00:00 [pmc-release]
AID - toxins12050315 [pii]
AID - toxins-12-00315 [pii]
AID - 10.3390/toxins12050315 [doi]
PST - epublish
SO  - Toxins (Basel). 2020 May 10;12(5):315. doi: 10.3390/toxins12050315.