1000 Section - Spasticity and clonus management of outpatient multiple sclerosis patients with botulinum toxin a rehabilitation center

The management of regional spasticity with botulinum toxin type A (BNT-A) is common medical practice for multiple sclerosis (MS) patients.
To highlight the necessity of BNT-A regonal spasticity treatment of patients with MS during their outpatient rehabilitation and the targeting of muscles according to the principles of Neurorehabilitation

Design:

42 patients with MS with clinical signs of regional spasticity and clonus were assessed at our Outpatient Rehabilitation Clinic during a one year period from 6/2023 to 6/2024,   25 /42  women and 17/42 men.Their spasticity grade was according to  mAshworth scale between 1-3 with a mean values of 1.9.  All patients had clinical manifestation of incomplete spinal cord lesion with satisfactory cognitive capacity. 

6/42 (14.2%), presented spasticity in the upper and lower limbs  while  36/42 (85.7%) only in the lower limbs.26/45 (61.9%) from patients with lower limb spasticity had clinical sign of ankle joint clonus .  8/42 (19.04%) where wheelchair users while 80.9% presented midscale to severe difficulty ambulating with spastic equinovarus and common falls. BNT-A was injected with EMG guidance and electrostimulation

Results:

6 /42 of the patients (14.2%) were injected in both upper and lower limbs from which  only  2 /42  (4,7%) in both upper limbs.

15/42 (35.7%) were injected at the adductors bilateraly  and  35/42 ( 83.3%) in both lower limbs  and  7/45 (16.6%) in lower limb unilaterally targeted muscles: soleus, gastrocnemius both heads and tibialis posterior 6/42 (14.2%) of the patients were treated at the  extensor hallucis longus and 12/42 (28.5%)  at the flexor hallucis longus.Within the year of the study   32/45 (76.19%) had 2 treatment sessions whereas 6/42(14.2%) 3. All patients underwent an outpatient rehabilitation program with functional improvement.

Conclusion: BNT-A treatment of patients with MS is a safe and effective spasticity treatment  method that contributes to a favorable rehabilitation outcome.