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

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

Publication date: Jun 20, 2019

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.

De Icco, R., Perrotta, A., Berra, E., Allena, M., Alfonsi, E., Tamburin, S., Serrao, M., Sandrini, G., and Tassorelli, C. OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity. 18390. 2019 Toxins (Basel) (11):6.

Concepts Keywords
Basel Units site
Botulinum Neurotoxin Muscle tone disorder
Chronic Pain Pain
Disability Perception
MAS Organ systems
Multiple Sclerosis Nociception
Muscle Tone Sensory systems
Neurological Spasticity
Neuropathic Botulinum toxin
Neuropathic Pain Neuropathic pain
Neurophysiological Chronic pain
Nociception Withdrawal reflex
Nociceptive Spinal cord
OnabotulinumtoxinA Tetraplegia
Pain
Spasticity
Spinal Cord
Spinal Cord Injury
Stroke

Semantics

Type Source Name
gene UNIPROT MAS1
gene UNIPROT SPNS1
disease MESH neuropathic pain
pathway BSID Spinal Cord Injury
disease DOID multiple sclerosis
disease MESH multiple sclerosis
disease DOID stroke
disease MESH stroke
drug DRUGBANK Pentaerythritol tetranitrate
gene UNIPROT DNMT1
gene UNIPROT CD69
gene UNIPROT CD5L
disease MESH chronic pain
drug DRUGBANK Botulinum Toxin Type A

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