Do Diagnostic Nerve Blocks Affect the Starting Dose of Botulinum Neurotoxin Type A for Spasticity? A Case-Control Study
Mirko Filippetti,
Stefano Tamburin,
Rita Di Censo,
Roberto Aldegheri,
Elisa Mantovani,
Stefania Spina,
Marco Battaglia,
Alessio Baricich,
Andrea Santamato,
Nicola Smania,
Alessandro Picelli
Affiliations
Mirko Filippetti
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
Stefano Tamburin
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
Rita Di Censo
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
Roberto Aldegheri
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
Elisa Mantovani
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
Stefania Spina
Spasticity and Movement Disorders ‘ReSTaRt’ Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital University of Foggia, 71122 Foggia, Italy
Marco Battaglia
Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy
Alessio Baricich
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
Andrea Santamato
Spasticity and Movement Disorders ‘ReSTaRt’ Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital University of Foggia, 71122 Foggia, Italy
Nicola Smania
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
Alessandro Picelli
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
One of the aims of diagnostic nerve blocks is to identify the overactive muscles that lead to a specific spasticity pattern. However, to date, there is no evidence on how nerve blocks may affect botulinum neurotoxin-A (BoNT-A) dose in patients with spasticity. This case-control study aims to assess the role of diagnostic nerve block in defining BoNT-A starting dose at first treatment. Patients with upper and lower limb spasticity treated for the first time with BoNT-A were retrospectively divided into two groups: Group 1 (n = 43) was evaluated with clinical assessment and diagnostic nerve block; Group 2 (n = 56) underwent clinical assessment only. Group 1 was injected with higher BoNT-A doses in some muscles (i.e., flexor digitorum profundus, soleus), and received a higher BoNT-A cumulative dose with a larger number of injected muscles for some spasticity patterns (i.e., “clenched fist”, “flexed fingers”, “adducted thigh”). Diagnostic nerve block may help the clinician to optimize and personalize the BoNT-A dose since the first BoNT-A treatment.
