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Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force

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Abstract

Botulinum toxin (BT) therapy is an established treatment of spasticity due to stroke. For multiple sclerosis (MS) spasticity this is not the case. IAB-Interdisciplinary Working Group for Movement Disorders formed a task force to explore the use of BT therapy for treatment of MS spasticity. A formalised PubMed literature search produced 55 publications (3 randomised controlled trials, 3 interventional studies, 11 observational studies, 2 case studies, 35 reviews, 1 guideline) all unanimously favouring the use of BT therapy for MS spasticity. There is no reason to believe that BT should be less effective and safe in MS spasticity than it is in stroke spasticity. Recommendations include an update of the current prevalence of MS spasticity and its clinical features according to classifications used in movement disorders. Immunological data on MS patients already treated should be analysed with respect to frequencies of MS relapses and BT antibody formation. Registration authorities should expand registration of BT therapy for spasticity regardless of its aetiology. MS specialists should consider BT therapy for symptomatic treatment of spasticity.

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Authors and Affiliations

  1. Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Dirk Dressler

  2. Chulalongkorn Centre for Excellence on Parkinson’s Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Roongroj Bhidayasiri

  3. Department of Neurology, King Faisal Specialist Hospital, Riyadh, Kingdom of Saudi Arabia

    Saeed Bohlega

  4. Basic and Clinical Neurosciences Research Laboratory, University Medical School of Marrakech, Marrakech, Morocco

    Abderrahmane Chahidi

  5. University of Sao Paulo, Sao Paulo, Brazil

    Tae Mo Chung

  6. Department of Neurology, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht, Germany

    Markus Ebke

  7. Department of Adult Neuro-Rehabilitation, Adult Botulinum Toxin Clinics, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal

    L. Jorge Jacinto

  8. Department of Neurology, University of Tokushima, Tokushima, Japan

    Ryuji Kaji

  9. Centre de Rééducation et Medicine Physique, Hôpital du Jura, Porrentruy, Switzerland

    Serdar Koçer

  10. Department of Neurology, Palacky University, Olomouc, Czech Republic

    Petr Kanovsky

  11. Department of Neurology, Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina

    Federico Micheli

  12. Clinic ‘Cecil Plus’, Moscow, Russia

    Olga Orlova

  13. Department of Neurology, Bonn University, Bonn, Germany

    Sebastian Paus

  14. Department of Neurology, Ljubljana University Medical Centre, Ljubljana, Slovenia

    Zvezdan Pirtosek

  15. Department of Neurology, University of Zagreb, Zagreb, Croatia

    Maja Relja

  16. Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines

    Raymond L. Rosales

  17. Department of Neurology, Universidad de Monterrey, Monterrey, Mexico

    José Alberto Sagástegui-Rodríguez

  18. Department of Neurology, Maternus-Klinik für Rehabilitation, Bad Oeynhausen, Germany

    Paul W. Schoenle

  19. Department of Neurology, Movement Disorders Clinic, Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

    Gholam Ali Shahidi

  20. Scientific Research Institute of Neurology, Moscow, Russia

    Sofia Timerbaeva

  21. Department of Neurology, Rostock University, Rostock, Germany

    Uwe Walter

  22. IAB-Interdisciplinary Working Group for Movement Disorders, Hamburg, Germany

    Fereshte Adib Saberi

Authors
  1. Dirk Dressler
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  2. Roongroj Bhidayasiri
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  3. Saeed Bohlega
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  4. Abderrahmane Chahidi
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  5. Tae Mo Chung
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  6. Markus Ebke
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  7. L. Jorge Jacinto
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  8. Ryuji Kaji
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  9. Serdar Koçer
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  10. Petr Kanovsky
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  11. Federico Micheli
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  12. Olga Orlova
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  13. Sebastian Paus
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  14. Zvezdan Pirtosek
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  15. Maja Relja
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  16. Raymond L. Rosales
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  17. José Alberto Sagástegui-Rodríguez
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  18. Paul W. Schoenle
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  19. Gholam Ali Shahidi
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  20. Sofia Timerbaeva
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  21. Uwe Walter
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  22. Fereshte Adib Saberi
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Corresponding author

Correspondence to Dirk Dressler.

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Conflicts of interest

Dressler D: DD received honoraria for services provided to Allergan, Ipsen, Merz, Desitin, Syntaxin, Abbvie, Medtronic, St Jude, Boston Scientific, Almirall, Bayer, Sun, Teva, UCB, IAB-Interdisciplinary Working Group for Movement Disorders. He is shareholder of Allergan and holds patents on botulinum toxin and botulinum toxin therapy. Bhidayasiri R: RB is supported by Thailand Research Fund, Chulalongkorn Academic Advancement into its 2nd Century Project, and Ratchadapiseksompoj grant of Chulalongkorn University. He is an advisory board member of Britannia Pharmaceuticals; receives honoraria from Novartis, Ipsen, GlaxoSmithKline, and BL Hua pharmaceuticals; and royalties from Wiley-Blackwell and Humana press. He is an associate editor of BMC Neurology and Journal of Clinical Movement Disorder; and on the editorial board of Parkinsonism and Related Disorders journal and Journal of the Neurological Sciences. Bohlega S: SB has nothing to declare. Chahidi A: AC has nothing to declare. Ebke M: ME has nothing to declare. Jacinto J: JJ has received financial support from Ipsen, Allergan and Merz companies as an expert advisor, lecturer/speaker, researcher, peer trainer in the fields of spasticity management and neuro-rehabilitation. He owns no shares nor has any other relation with the above-mentioned companies. Kaji RE: RK received honoraria from Ipsen, GSK, Eisai and Merz to lecture in symposiums, and training courses and for advisory board participation. He participated in several clinical research trials from Merz. He holds a patent on A2NTX. Kanovsky P: PK has received speaker´s honoraria from Merz, Ipsen, Allergan, Medtronic, Novartis, AbbVie and Desitin. Micheli F: FM has nothing to declare. Orlova O: OO is scientific consultant for Allergan, Ipsen, Merz, MSD. Paus S: SP received honoraria for services provided from Allergan, Ipsen and Merz. Pirtosek Z: DP received compensation for speaker related activities from Pharmaswiss and Medis. Sagástegui-Rodríguez A: ASR has nothing to declare. Schoenle PW: PWS has nothing to declare. Shahidi GA: GAS has nothing to declare. Tae MC: MCT received honoraria from Ipsen, Allergan and Merz to lecture in symposiums, and in training courses and to participate in advisory boards. He participated in clinical research from Ipsen. He did not receive any research funding and has no financial interest in BoNT. Timerbaeva S: ST has received speaker fees and meeting sponsorship from Ipsen and Merz companies. Walter U: UW has received research funds from Merz Pharmaceuticals and speaker honoraria and travel grants from Abbvie, Bayer Vital, Ipsen Pharma, Merz Pharmaceuticals and Pfizer. Adib Saberi F: FAS received honoraria for services provided from Abbott, Abbvie, Almirall, Allergan, Bayer, Desitin, Dynamed, Ipsen, Medtronic, Merz, Sintetica, Sun, Teva and UCB.

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Dressler, D., Bhidayasiri, R., Bohlega, S. et al. Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force. J Neurol 264, 112–120 (2017). https://doi.org/10.1007/s00415-016-8304-z

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