Which complementary therapies are used in combination with BoNT-A for the treatment of spasticity?

Updated: Jun 28, 2019
  • Author: Krupa Pandey, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

When used in the management of spasticity, treatment with BoNT-A is almost never used as monotherapy. Complementary therapies, such as physical and occupational therapy, frequently are utilized to maximize anticipated outcomes. These therapies usually are instituted or modified after injection. For example, in a controlled study in 20 children with upper limb spastic cerebral palsy, Kanellopoulos et al found that use of a static night splint after of BoNT-A injection resulted in significantly better results after 6 months. [32]

The above-mentioned study by Molenaers and colleagues found that, in addition to the injection strategy, factors in achieving a successful outcome in BoNT-A therapy included the following [39] :

  • Amount of physical therapy per week

  • Postinjection casting

  • Frequency with which day and night orthoses were used after injection

Treatment with BoNT-A can be combined with various oral medications, the baclofen pump, and sometimes with phenol or alcohol neurolysis. The primary reason for combining BoNT-A with phenol or alcohol neurolysis would be to avoid loss of responsiveness by remaining under the maximum dose per visit.

The decision to combine therapies usually depends on the location and number of target muscles involved. If both lower and upper extremities are to be injected, the combination of BoNT-A and phenol may be warranted. Although using phenol or alcohol neurolysis is associated with certain difficulties, they provide inexpensive, long-term chemodenervation for some patients, mainly adults.


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