OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity
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...
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doaj-fd2f71cfe331464280d6776a575352f92020-11-25T01:57:01ZengMDPI AGToxins2072-66512019-06-0111635910.3390/toxins11060359toxins11060359OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb SpasticityRoberto De Icco0Armando Perrotta1Eliana Berra2Marta Allena3Enrico Alfonsi4Stefano Tamburin5Mariano Serrao6Giorgio Sandrini7Cristina Tassorelli8Neurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, ItalyIRCCS Neuromed, 86077 Pozzilli, IS, ItalyNeurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, ItalyNeurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, ItalyDepartment of Neurophysiopathology, IRCCS Mondino Foundation, 27100 Pavia, ItalyDepartment of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, ItalyDepartment of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00100 Rome, ItalyNeurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, ItalyNeurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, ItalySpasticity 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.https://www.mdpi.com/2072-6651/11/6/359botulinum toxinspasticityneuropathic painlower limb reflexspinal temporal summationstrokemultiple sclerosisspinal cord injury |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Roberto De Icco Armando Perrotta Eliana Berra Marta Allena Enrico Alfonsi Stefano Tamburin Mariano Serrao Giorgio Sandrini Cristina Tassorelli |
spellingShingle |
Roberto De Icco Armando Perrotta Eliana Berra Marta Allena Enrico Alfonsi Stefano Tamburin Mariano Serrao Giorgio Sandrini Cristina Tassorelli OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity Toxins botulinum toxin spasticity neuropathic pain lower limb reflex spinal temporal summation stroke multiple sclerosis spinal cord injury |
author_facet |
Roberto De Icco Armando Perrotta Eliana Berra Marta Allena Enrico Alfonsi Stefano Tamburin Mariano Serrao Giorgio Sandrini Cristina Tassorelli |
author_sort |
Roberto De Icco |
title |
OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity |
title_short |
OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity |
title_full |
OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity |
title_fullStr |
OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity |
title_full_unstemmed |
OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity |
title_sort |
onabotulinumtoxina reduces temporal pain processing at spinal level in patients with lower limb spasticity |
publisher |
MDPI AG |
series |
Toxins |
issn |
2072-6651 |
publishDate |
2019-06-01 |
description |
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. |
topic |
botulinum toxin spasticity neuropathic pain lower limb reflex spinal temporal summation stroke multiple sclerosis spinal cord injury |
url |
https://www.mdpi.com/2072-6651/11/6/359 |
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