Botulinum toxin treatment for multiple sclerosis and post-stroke spasticity in clinical practice: differences in injection doses and patterns.
Paolo Manganotti, Alessandro Dinoto, Giulia Mazzon and 7 others
MS patients receive lower botulinum toxin doses and are injected in different muscles than stroke patients, yet both groups report similar benefit.
Dosing was individualized rather than protocol-driven.
Key findings
1MS patients more often had bilateral lower-limb spasticity (paraspasticity 42.4%, tetraspasticity 27.3%), while stroke patients more often had unilateral upper-limb patterns (monolateral upper limb 41.8%, hemispasticity 36.4%).
2MS patients received significantly lower cumulative doses of both toxin types. For incobotulinumtoxinA the median was 100 units (range 20-300) versus 230 units (range 130-400) in stroke patients; for onabotulinumtoxinA, 125 units (range 50-200) versus 200 units (range 25-400).
3Perceived treatment benefit was similar between groups: 90.6% of MS patients and 86.5% of stroke patients reported benefit from their injections.
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What it does not show
Retrospective design with no standardized spasticity, spasm, or pain scales; efficacy was captured only as a yes/no self-report of benefit, so the 90.6% and 86.5% figures cannot be compared with trials that use the Modified Ashworth Scale or Tardieu Scale. Single center in Italy; the authors note the findings may reflect local practice patterns rather than a generalizable difference between MS and stroke spasticity. Small sample (33 MS, 55 stroke), so the regression models have limited power and the predictive findings should be read cautiously. No randomization and no control group; the association between incobotulinumtoxinA and reported benefit is observational and confounded by the fact that the two groups differed in many other ways (spasticity pattern, number of limbs treated, number of muscles injected). No data on residual motor function or spasticity severity at the time of injection, so the reasons for the lower MS doses (preservation of function versus milder spasticity) cannot be fully separated.
Declared interests
The authors declared that no financial support was received for the work or its publication.
The easy way to misread this
Do not read the association between incobotulinumtoxinA and reported benefit as evidence that one toxin outperforms the other. The study had no randomization, no standardized outcome measures, and the two groups differed in spasticity pattern, number of limbs treated, and number of muscles injected, so the toxin type is confounded with many other variables.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →