Muscle selection and dosing in patients undergoing treatment with abobotulinumtoxinA for lower limb spasticity in real-world practice.
Richard D Zorowitz, Jorge Jacinto, Stephen Ashford and 4 others
PMID 39916528WHAT IT FOUND
In real-world practice, clinicians injected a median of 600 units of abobotulinumtoxinA into the lower limbs, targeting six specific muscles.
Patients with upper limb spasticity received lower leg doses to stay within total body limits. Most also received concurrent therapy.
Key findings
01The median total dose injected into the lower limb was 600 U, targeting a median of 4 muscles per cycle.
02Patients who received injections in both the upper and lower limbs received a median lower limb dose of 567 U, compared to 771 U for those receiving lower limb injections only.
03The most commonly injected muscles were the gastrocnemius medial and lateral heads, soleus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was observational, so it describes practice patterns but cannot establish causal relationships between dosing and outcomes. There were considerable missing data regarding non-pharmacological treatments due to the observational nature of the study. The study population was limited to ambulatory patients (able to take ≥ 5 steps), so findings may not apply to non-ambulatory patients. Important regions such as Asia were not included, where dosing practices may differ. The study did not capture whether pain medications targeted the lower limb specifically. Participants were recruited from expert neurorehabilitation centres, which may not reflect general community practice.
Declared interests
The study was funded by Ipsen, the manufacturer of abobotulinumtoxinA (Dysport). The authors declared conflicts of interest related to this funding.
The easy way to misread this
Do not interpret the lower doses observed in this study as evidence of optimal or insufficient treatment. The study reports what clinicians did in real-world practice without comparing outcomes across different dose levels, so it does not prove that these doses were effective or that higher doses would have been better.