BoNT-A for Post-Stroke Spasticity: Guidance on Unmet Clinical Needs from a Delphi Panel Approach
Alessio Baricich,
Theodore Wein,
Nicoletta Cinone,
Michele Bertoni,
Alessandro Picelli,
Carmelo Chisari,
Franco Molteni,
Andrea Santamato
Affiliations
Alessio Baricich
Physical Medicine and Rehabilitation, Department of Health Sciences, Università del Piemonte Orientale, viale Piazza d’armi 1, 28100 Novara, Italy
Theodore Wein
Department of Neurology and Neurosurgery, McGill University, Montreal, QC H3A 0G4, Canada
Nicoletta Cinone
Physical Medicine and Rehabilitation, Spasticity and Movement Disorder Unit, Policlinico Riuniti, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
Michele Bertoni
Physical Medicine and Rehabilitation, ASST Sette Laghi, 21100 Varese, Italy
Alessandro Picelli
Neuromotor and Cognitive Rehabilitation Study and Research Centre, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37134 Verona, Italy
Carmelo Chisari
Unit of Neurorehabilitation, University Hospital of Pisa, 56126 Pisa, Italy
Franco Molteni
Villa Beretta Rehabilitation Center, Valduce Hospital, Via Nazario Sauro 17, 23845 Costa Masnaga, Italy
Andrea Santamato
Physical Medicine and Rehabilitation, Spasticity and Movement Disorder Unit, Policlinico Riuniti, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
There is extensive literature supporting the efficacy of botulinum toxin (BoNT-A) for the treatment of post-stroke spasticity, however, there remain gaps in the routine management of patients with post-stroke spasticity. A panel of 21 Italian experts was selected to participate in this web-based survey Delphi process to provide guidance that can support clinicians in the decision-making process. There was a broad consensus among physicians that BoNT-A intervention should be administered as soon as the spasticity interferes with the patients’ clinical condition. Patients monitoring is needed over time, a follow-up of 4–6 weeks is considered necessary. Furthermore, physicians agreed that treatment should be offered irrespective of the duration of the spasticity. The Delphi consensus also stressed the importance of patient-centered goals in order to satisfy the clinical needs of the patient regardless of time of onset or duration of spasticity. The findings arising from this Delphi process provide insights into the unmet needs in managing post-stroke spasticity from the clinician’s perspective and provides guidance for physicians for the utilization of BoNT-A for the treatment of post-stroke spasticity in daily practice.
