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. 2024 Sep 6;16(9):388.
doi: 10.3390/toxins16090388.

Do Diagnostic Nerve Blocks Affect the Starting Dose of Botulinum Neurotoxin Type A for Spasticity? A Case-Control Study

Mirko Filippetti  1   2 , Stefano Tamburin  1 , Rita Di Censo  1   3 , Roberto Aldegheri  1 , Elisa Mantovani  1 , Stefania Spina  4 , Marco Battaglia  5 , Alessio Baricich  6   7 , Andrea Santamato  4 , Nicola Smania  1   3 , Alessandro Picelli  1   2   3
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Do Diagnostic Nerve Blocks Affect the Starting Dose of Botulinum Neurotoxin Type A for Spasticity? A Case-Control Study

Mirko Filippetti et al. Toxins (Basel). .

Abstract

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.

Keywords: botulinum neurotoxin; drug utilization; muscle spasticity; nerve block; ultrasonography.

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Conflict of interest statement

The authors declare no conflicts of interest.

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