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Patient Perspectives on the Therapeutic Profile of Botulinum Neurotoxin Type A in Spasticity
Background: Botulinum toxin-A (BoNT-A) injections are first-line treatment for adult spasticity. Prior patient surveys have reported that BoNT-A treatment improves quality of life but that symptoms usually recur before the next injection. We aimed to explore, in-depth, patient perceptions of the imp...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233119/ https://www.ncbi.nlm.nih.gov/pubmed/32477251 http://dx.doi.org/10.3389/fneur.2020.00388 |
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author | Jacinto, Jorge Varriale, Pasquale Pain, Emilie Lysandropoulos, Andreas Esquenazi, Alberto |
author_facet | Jacinto, Jorge Varriale, Pasquale Pain, Emilie Lysandropoulos, Andreas Esquenazi, Alberto |
author_sort | Jacinto, Jorge |
collection | PubMed |
description | Background: Botulinum toxin-A (BoNT-A) injections are first-line treatment for adult spasticity. Prior patient surveys have reported that BoNT-A treatment improves quality of life but that symptoms usually recur before the next injection. We aimed to explore, in-depth, patient perceptions of the impact of spasticity and the waning of BoNT-A therapeutic effects. Methods: An internet-based survey was conducted through Carenity, an online patient community, from May to September 2019 in France, Germany, Italy, UK and USA. Eligible respondents were adult patients with spasticity due to stroke, traumatic brain injury (TBI) or spinal cord injury (SCI) who had ≥2 previous BoNT-A injections. Results: Two hundred and ten respondents (mean 47.2 years) met screening criteria and had their responses analyzed. Overall, 43% of respondents had spasticity due to stroke, 30% due to TBI and 27% due to SCI. The mean [95% CI] injection frequency for spasticity management was 3.6 [3.4–3.7] injections/year. Respondents described the time profile of their response to BoNT-A. The mean reported onset of therapeutic effect was 12.9 [12.1–13.7] days and the mean time to peak effect was 5.0 [4.7–5.4] weeks. Symptom re-emergence between injections was common (83%); the time from injection to symptom re-emergence was 89.4 [86.3–92.4] days. Muscle spasms usually re-emerge first (64%), followed by muscle stiffness or rigidity (40%), and limb pain (20%). Over half (52%) of respondents said they had lost their self-confidence, 46% experienced depression and 41% experienced a lack of sleep due to their spasticity symptoms in the past 12 months. Following a report of symptom re-emergence, the most common management approaches were to add adjunctive treatments (36%), increase the BoNT-A dose (28%), and wait for the next injection (27%). Seventy two percentage of respondents said they would like a longer lasting BoNT-A treatment. Conclusions: Patients with spasticity can expect a characteristic profile of BoNT-A effects, namely time lag to onset and peak effect followed by a gradual decline in the symptomatic benefits. Symptom re-emergence is common and has significant impact on quality of life. Greater patient/clinician awareness of this therapeutic profile should lead to better level of overall satisfaction with treatment, informed therapeutic discussions and treatment schedule planning. |
format | Online Article Text |
id | pubmed-7233119 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-72331192020-05-29 Patient Perspectives on the Therapeutic Profile of Botulinum Neurotoxin Type A in Spasticity Jacinto, Jorge Varriale, Pasquale Pain, Emilie Lysandropoulos, Andreas Esquenazi, Alberto Front Neurol Neurology Background: Botulinum toxin-A (BoNT-A) injections are first-line treatment for adult spasticity. Prior patient surveys have reported that BoNT-A treatment improves quality of life but that symptoms usually recur before the next injection. We aimed to explore, in-depth, patient perceptions of the impact of spasticity and the waning of BoNT-A therapeutic effects. Methods: An internet-based survey was conducted through Carenity, an online patient community, from May to September 2019 in France, Germany, Italy, UK and USA. Eligible respondents were adult patients with spasticity due to stroke, traumatic brain injury (TBI) or spinal cord injury (SCI) who had ≥2 previous BoNT-A injections. Results: Two hundred and ten respondents (mean 47.2 years) met screening criteria and had their responses analyzed. Overall, 43% of respondents had spasticity due to stroke, 30% due to TBI and 27% due to SCI. The mean [95% CI] injection frequency for spasticity management was 3.6 [3.4–3.7] injections/year. Respondents described the time profile of their response to BoNT-A. The mean reported onset of therapeutic effect was 12.9 [12.1–13.7] days and the mean time to peak effect was 5.0 [4.7–5.4] weeks. Symptom re-emergence between injections was common (83%); the time from injection to symptom re-emergence was 89.4 [86.3–92.4] days. Muscle spasms usually re-emerge first (64%), followed by muscle stiffness or rigidity (40%), and limb pain (20%). Over half (52%) of respondents said they had lost their self-confidence, 46% experienced depression and 41% experienced a lack of sleep due to their spasticity symptoms in the past 12 months. Following a report of symptom re-emergence, the most common management approaches were to add adjunctive treatments (36%), increase the BoNT-A dose (28%), and wait for the next injection (27%). Seventy two percentage of respondents said they would like a longer lasting BoNT-A treatment. Conclusions: Patients with spasticity can expect a characteristic profile of BoNT-A effects, namely time lag to onset and peak effect followed by a gradual decline in the symptomatic benefits. Symptom re-emergence is common and has significant impact on quality of life. Greater patient/clinician awareness of this therapeutic profile should lead to better level of overall satisfaction with treatment, informed therapeutic discussions and treatment schedule planning. Frontiers Media S.A. 2020-05-07 /pmc/articles/PMC7233119/ /pubmed/32477251 http://dx.doi.org/10.3389/fneur.2020.00388 Text en Copyright © 2020 Jacinto, Varriale, Pain, Lysandropoulos and Esquenazi. http://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 Jacinto, Jorge Varriale, Pasquale Pain, Emilie Lysandropoulos, Andreas Esquenazi, Alberto Patient Perspectives on the Therapeutic Profile of Botulinum Neurotoxin Type A in Spasticity |
title | Patient Perspectives on the Therapeutic Profile of Botulinum Neurotoxin Type A in Spasticity |
title_full | Patient Perspectives on the Therapeutic Profile of Botulinum Neurotoxin Type A in Spasticity |
title_fullStr | Patient Perspectives on the Therapeutic Profile of Botulinum Neurotoxin Type A in Spasticity |
title_full_unstemmed | Patient Perspectives on the Therapeutic Profile of Botulinum Neurotoxin Type A in Spasticity |
title_short | Patient Perspectives on the Therapeutic Profile of Botulinum Neurotoxin Type A in Spasticity |
title_sort | patient perspectives on the therapeutic profile of botulinum neurotoxin type a in spasticity |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233119/ https://www.ncbi.nlm.nih.gov/pubmed/32477251 http://dx.doi.org/10.3389/fneur.2020.00388 |
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