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. 2022 Jan 3:54:jrm00241.
doi: 10.2340/16501977-2877.

European expert consensus on improving patient selection for the management of disabling spasticity with intrathecal baclofen and/or botulinum toxin type A

Bo Biering-Soerensen  1 , Valerie Stevenson, Djamel Bensmail, Klemen Grabljevec, Mercedes Martínez Moreno, Elke Pucks-Faes, Joerg Wissel, Mauro Zampolini
Affiliations

European expert consensus on improving patient selection for the management of disabling spasticity with intrathecal baclofen and/or botulinum toxin type A

Bo Biering-Soerensen et al. J Rehabil Med. .

Abstract

Objective: To develop an algorithm for the selection of adults with disabling spasticity for treatment with intrathecal baclofen (ITB) and/or botulinum toxin type A (BoNT A).

Methods: A European Advisory Board of 4 neurologists and 4 rehabilitation specialists performed a literature review on ITB and BoNT A treatment for disabling spasticity. An online survey was sent to 125 physicians and 13 non-physician spasticity experts. Information on their current clinical practice and level of agreement on proposed selection criteria was used to inform algorithm design. Consensus was considered reached when ≥75% of respondents agreed or were neutral.

Results: A total of 79 experts from 17 countries completed the on-line survey (57%). Agreement was reached that patients with multi-segmental or generalized disabling spasticity refractory to oral drugs are the best candidates for ITB (96.1% consensus), while those with focal/segmental disabling spasticity are ideal candidates for BoNT A (98.7% consensus). In addition the following are good candidates for ITB (% consensus): bilateral disabling spasticity affecting lower limbs only (97.4%), bilateral (100%) or unilateral (90.9%) disabling spasticity affecting lower limbs and trunk, and unilateral or bilateral disabling spasticity affecting upper and lower extremities (96.1%).

Conclusion: This algorithm will support the management of adult patients with disabling spasticity by aiding patient selection for ITB and/or BoNT A treatments.

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Conflict of interest statement

The Advisory Board and the publication fees were supported by Medtronic.

Figures

Fig. 1
Fig. 1
Parameters considered by experts when selecting (a) intrathecal baclofen (ITB) or (b) botulinum toxin (BoNT) treatment for the management of disabling spasticity.
Fig. 2
Fig. 2
Algorithm developed by the expert panel for the management of adult patients with disabling spasticity who are potential candidates for intrathecal baclofen (ITB) or botulinum toxin (BoNT)
See this image and copyright information in PMC

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