Highlights from

TOXINS 2019

International Neurotoxin Association (INA) annual meeting

Copenhagen 16-19 January 2019

Why treat spasticity?

"Spasticity is a costly thing to have", Dr Anthony Ward (University Hospital of North Staffordshire, United Kingdom) said in his lecture, focusing on treatment considerations in focal and multi-focal spasticity.

Features of spasticity are shortened overactive muscles, muscle spasms, stiff limbs, hypertonia, limb posture change, weakness masked by stiffness, loss of fine motor control, and fatigue, Dr Ward reminded the audience. Among the impacts of adult spasticity are an impaired ability to perform everyday tasks, decreased mobility associated with pain, sleep disturbances, and mood changes, which all lead to a reduced quality of life.

According to Dr Ward, botulinum toxin injections are indicated for improvement of function (i.e. mobility, dexterity) and symptom relief to ease pain (i.e. muscle shortening, tendon pain, postural effects). He suggested this therapeutic approach for decreasing spasms, avoiding unnecessary treatments, reducing complications, facilitating therapy, delaying/preventing surgery, and reducing caregiver burden when handling the patients [1]. Toxin treatment may also allow better toleration of splints and physical treatment, he added.

Do not hesitate, treatment is safe

In the BEST trial, Dr Ward et al. looked at costs. "While it looks expensive, it actually is good for the patients. Post-stroke patients with spasticity are expensive anyway, because these patients need intermittent rehabilitation.” Even 4 years after a stroke occurred, clinically meaningful outcomes can still be achieved by rehabilitation methods, he emphasised. For post-stroke patients, standard of care is important, he said, pointing out that that botulinum toxin A is an important adjunctive treatment to standard of care. Addition of botulinum toxin A after preparing muscles for treatment with physical therapy can significantly improve patients goal achievement [2]. Dr Ward urged: "start treatment immediately. Do not wait, we know that treatment is safe." Early mobilisation is important in stroke patients.

The content and interpretation of these conference highlights are the views and comments of the speakers/authors.