Early pain reduction in the treatment of spasticity after a single injection of botulinum A toxin

• Published in: Deutsche medizinische Wochenschrift Vol. 126; no. 48; p. 1361
• Main Authors: Chalkiadaki, A, Rohr, U P, Hefter, H
• Format: Journal Article
• Language: German
• Published: Germany 30.11.2001
• Subjects: Aged; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - therapeutic use; Female; Hematopoietic Stem Cell Transplantation; Humans; Injections, Intramuscular; Middle Aged; Muscle Spasticity - drug therapy; Neuromuscular Agents - administration & dosage; Neuromuscular Agents - therapeutic use; Neurotransmitter Agents - antagonists & inhibitors; Pain - drug therapy; Quality of Life; Time Factors; Treatment Outcome
• ISSN: 0012-0472
• DOI: 10.1055/s-2001-18651

HISTORY, ADMISSION FINDINGS AND DIAGNOSIS: After stem-cell transplantation a 45-year-old woman (case 1) had an attack of general hypoxia requiring resuscitation. She then developed a quadriplegia and spasticity of all limbs notably of the right arm and a severe pain syndrome which had to be treated by oral and intravenous analgesics. Immobilisation and secondary complications aggravated the already difficult situation. In the 2nd case a 66-year-old woman was admitted to our outpatient clinic with long-standing left-sided spastic hemiparesis after territorial infarction of the right middle cerebral artery. Beside the spasticity she also suffered from a distinct pain syndrome which did not respond to any oral analgesics. For the treatment of the main symptoms, both patients received intramuscular injections of 1000 MU botulinum toxin A (Dysport(R) Ipsen Pharma). Astonishingly, both patients experienced pain relief the next day, whereas spasticity started to respond only 5-6 days later. In our experience pain relief after botulinum toxin A injections occurs not only due to reduced muscle hyperactivity, especially when such a temporal dissociation between pain relief and muscle relaxation appears as in the two cases reported above. Rather, we believe that botulinum toxin A interferes with the release of other neurotransmitters e. g. substance P (SP) and calcitonine-gene-related-peptide (CGRP) having a key function in the nociceptive cascade.