Spasticity Management with Botulinum Toxin in Post-stroke and Multiple Sclerosis Patients: A Retrospective, 'Real-world', Multicenter Study

Background: While there is strong evidence for botulinum toxin-A (BoNT-A) in post-stroke spasticity, there is a paucity of data in multiple sclerosis and other conditions in real-world settings. Objective: Document the use of BoNT-A in the management of spasticity, with focus on the treatment of spasticity due to stroke and multiple sclerosis. Methods: This noninterventional, retrospective study included all adults treated for upper and/or lower limb spasticity (any etiology) at three centers in Italy who received >= 3 BoNT-A injection cycles between 2008 and 2018. Results: Injection data from 149 patients were analyzed (n = 67 post-stroke, n = 47 MS, n = 35 other etiologies). The median treatment duration was 54.9 months in the post-stroke population and 41.9 months in the MS population. Total doses for the commercially available BoNT-A formulations were typically lower than approved for use in spasticity; we also observed clinically relevant differences in the muscle patterns treated between the MS and post-stroke indications. Regardless of etiology, most patients were satisfied with treatment. Conclusions: This retrospective study provides a snapshot of spasticity management for patients referred for BoNT-A treatment. Most patients were satisfied with their treatment over several cycles and the data support the effectiveness of BoNT-A for focal spasticity regardless of etiology.