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Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France

BACKGROUND: Current guidelines recommend intramuscular botulinum toxin type A (BoNT-A) injection as first-line treatment for spasticity, a frequent and impairing feature of various central nervous system (CNS) lesions such as stroke. Patients with spasticity commonly require BoNT-A injections once e...

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Autores principales: Levy, Jonathan, Karam, Pierre, Forestier, Anne, Loze, Jean-Yves, Bensmail, Djamel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482253/
https://www.ncbi.nlm.nih.gov/pubmed/37681005
http://dx.doi.org/10.3389/fneur.2023.1245228
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author Levy, Jonathan
Karam, Pierre
Forestier, Anne
Loze, Jean-Yves
Bensmail, Djamel
author_facet Levy, Jonathan
Karam, Pierre
Forestier, Anne
Loze, Jean-Yves
Bensmail, Djamel
author_sort Levy, Jonathan
collection PubMed
description BACKGROUND: Current guidelines recommend intramuscular botulinum toxin type A (BoNT-A) injection as first-line treatment for spasticity, a frequent and impairing feature of various central nervous system (CNS) lesions such as stroke. Patients with spasticity commonly require BoNT-A injections once every 3 to 4 months. We conducted a nationwide, population-based, retrospective cohort study, using the French National Hospital Discharge Database (PMSI), to describe BoNT-A use for spasticity in clinical practice in France between 2014 and 2020. The PMSI database covers the whole French population, corresponding to over 66 million persons. METHODS: We first searched the PMSI database for healthcare facility discharge of patients who received BoNT-A injections between 2014 and 2020, corresponding to the first set. For each BoNT-A-treated patient, we identified the medical condition for which BoNT-A may have been indicated. Another search of the PMSI database focused on patients admitted for acute stroke between 2014 and 2016 and their spasticity-related care pathway (second set). Overall, two subpopulations were analysed: 138,481 patients who received BoNT-A injections between 2014 and 2020, and 318,025 patients who survived a stroke event between 2014 and 2016 and were followed up until 2020. RESULTS: Among the 138,481 BoNT-A-treated patients, 53.5% received only one or two BoNT-A injections. Most of these patients (N = 85,900; 62.0%) received BoNT-A because they had CNS lesions. The number of patients with CNS lesions who received ≥1 BoNT-A injection increased by a mean of 7.5% per year from 2014 to 2019, but decreased by 0.2% between 2019 and 2020, corresponding to the COVID-19 outbreak. In stroke survivors (N = 318,025), 10.7% were coded with post-stroke spasticity, 2.3% received ≥1 BoNT-A injection between 2014 and 2020, and only 0.8% received ≥3 injections within the 12 months following BoNT-A treatment initiation, i.e., once every 3 to 4 months. CONCLUSION: Our analysis of the exhaustive PMSI database showed a suboptimal implementation of BoNT-A treatment recommendations in France. BoNT-A treatment initiation and re-administration are low, particularly in patients with post-stroke spasticity. Further investigations may help explain this observation, and may target specific actions to improve spasticity-related care pathway.
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spelling pubmed-104822532023-09-07 Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France Levy, Jonathan Karam, Pierre Forestier, Anne Loze, Jean-Yves Bensmail, Djamel Front Neurol Neurology BACKGROUND: Current guidelines recommend intramuscular botulinum toxin type A (BoNT-A) injection as first-line treatment for spasticity, a frequent and impairing feature of various central nervous system (CNS) lesions such as stroke. Patients with spasticity commonly require BoNT-A injections once every 3 to 4 months. We conducted a nationwide, population-based, retrospective cohort study, using the French National Hospital Discharge Database (PMSI), to describe BoNT-A use for spasticity in clinical practice in France between 2014 and 2020. The PMSI database covers the whole French population, corresponding to over 66 million persons. METHODS: We first searched the PMSI database for healthcare facility discharge of patients who received BoNT-A injections between 2014 and 2020, corresponding to the first set. For each BoNT-A-treated patient, we identified the medical condition for which BoNT-A may have been indicated. Another search of the PMSI database focused on patients admitted for acute stroke between 2014 and 2016 and their spasticity-related care pathway (second set). Overall, two subpopulations were analysed: 138,481 patients who received BoNT-A injections between 2014 and 2020, and 318,025 patients who survived a stroke event between 2014 and 2016 and were followed up until 2020. RESULTS: Among the 138,481 BoNT-A-treated patients, 53.5% received only one or two BoNT-A injections. Most of these patients (N = 85,900; 62.0%) received BoNT-A because they had CNS lesions. The number of patients with CNS lesions who received ≥1 BoNT-A injection increased by a mean of 7.5% per year from 2014 to 2019, but decreased by 0.2% between 2019 and 2020, corresponding to the COVID-19 outbreak. In stroke survivors (N = 318,025), 10.7% were coded with post-stroke spasticity, 2.3% received ≥1 BoNT-A injection between 2014 and 2020, and only 0.8% received ≥3 injections within the 12 months following BoNT-A treatment initiation, i.e., once every 3 to 4 months. CONCLUSION: Our analysis of the exhaustive PMSI database showed a suboptimal implementation of BoNT-A treatment recommendations in France. BoNT-A treatment initiation and re-administration are low, particularly in patients with post-stroke spasticity. Further investigations may help explain this observation, and may target specific actions to improve spasticity-related care pathway. Frontiers Media S.A. 2023-08-23 /pmc/articles/PMC10482253/ /pubmed/37681005 http://dx.doi.org/10.3389/fneur.2023.1245228 Text en Copyright © 2023 Levy, Karam, Forestier, Loze and Bensmail. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Levy, Jonathan
Karam, Pierre
Forestier, Anne
Loze, Jean-Yves
Bensmail, Djamel
Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France
title Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France
title_full Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France
title_fullStr Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France
title_full_unstemmed Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France
title_short Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France
title_sort botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from france
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482253/
https://www.ncbi.nlm.nih.gov/pubmed/37681005
http://dx.doi.org/10.3389/fneur.2023.1245228
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