Contributions
Abstract: EP1692
Type: Poster Sessions
Abstract Category: Therapy - Symptomatic treatment
Introduction: Spasticity is a common symptom affecting people with multiple sclerosis (MS) and has a significant impact on quality of life. Treatment options include oral medications, botulinum toxin and intrathecal baclofen however these interventions may be ineffective or not suitable for people with advanced MS and severe lower limb (LL) spasticity.
Intrathecal phenol treatment (ITP) is an effective option in such people, but due to its destructive nature has not gained widespread use.
Objective: To review safety and efficacy of ITP in people with advanced MS and severe LL spasticity.
Methods: Data were collected prospectively from patients admitted for consideration of ITP between 2006 and 2018. Baseline demographics, spasticity assessment including Ashworth Scale for 12 muscle groups, Penn spasm frequency scale, passive range of motion (PM), numerical rating scales (NRS) and goals of treatment were collected. Prior to ITP a trial with intrathecal bupivicane was performed to confirm potential efficacy.
Results: 49 patients (mean age 51.5yrs,30 females) were admitted. Intrathecal bupivacaine was administered in 46 patients. 45 subjects proceded to ITP (39 bilateral, 6 unilateral); 2 patients did not proceed due to side effects of the bupivacaine trial and predicted failure to achieve goals. 2 patients neither underwent the trial nor ITP due to concerns regarding side effects or absence of severe spasticity. 1 patient proceeded directly to ITP as the potential risks of the trial outweighed the benefits.
Following ITP, there was a significant reduction in Ashworth scores (mean -14.64;p< 0.001), Penn scores (mean -2.92;p< 0.001), NRS for pain, comfort and spasticity(p< 0.001) and significant increases in PM at 5 LL joints (p< 0.01). Goals focussed on: ease of positioning (n=34), improved comfort (n=28), skin integrity (n=12), ease of personal care (n=33), pain (n=11), seating (n=17) and reduction of oral medications (n=23). All goals were achieved except 3 patients who did not achieve seating goal due to LL contractures.
ITP was well tolerated: adverse events included hypotension with intrathecal bupivicaine(n=9), myocardial infarction preventing treatment with ITP(n=1), infection(n=2), nausea(n=1).
16(35%) patients required repeat ITP after a mean interval of 11.4 months as spasticity and spasms returned.
Discussion: ITP is a highly effective option for severe LL spasticity, spasms and pain in appropriately selected patients with advanced MS.
Disclosure: Dr Sara Simeoni: nothing to disclose.
Elizabeth Keenan: nothing to disclose.
Katrina Buchanan: nothing to disclose.
Heesook Lee: nothing to disclose.
Corazon Padilla: nothing to disclose.
Dr Rachel Farrell has received honoraria / consultancy fees from Biogen Idec, Merck, TEVA Allergan PLC, Canbex Pharmaceuticals Ltd, GW Pharma. Dr Farrell's research is supported by the NIHR UCL Biomedical Research Centre.
Dr Valerie Stevenson: nothing to disclose.
Abstract: EP1692
Type: Poster Sessions
Abstract Category: Therapy - Symptomatic treatment
Introduction: Spasticity is a common symptom affecting people with multiple sclerosis (MS) and has a significant impact on quality of life. Treatment options include oral medications, botulinum toxin and intrathecal baclofen however these interventions may be ineffective or not suitable for people with advanced MS and severe lower limb (LL) spasticity.
Intrathecal phenol treatment (ITP) is an effective option in such people, but due to its destructive nature has not gained widespread use.
Objective: To review safety and efficacy of ITP in people with advanced MS and severe LL spasticity.
Methods: Data were collected prospectively from patients admitted for consideration of ITP between 2006 and 2018. Baseline demographics, spasticity assessment including Ashworth Scale for 12 muscle groups, Penn spasm frequency scale, passive range of motion (PM), numerical rating scales (NRS) and goals of treatment were collected. Prior to ITP a trial with intrathecal bupivicane was performed to confirm potential efficacy.
Results: 49 patients (mean age 51.5yrs,30 females) were admitted. Intrathecal bupivacaine was administered in 46 patients. 45 subjects proceded to ITP (39 bilateral, 6 unilateral); 2 patients did not proceed due to side effects of the bupivacaine trial and predicted failure to achieve goals. 2 patients neither underwent the trial nor ITP due to concerns regarding side effects or absence of severe spasticity. 1 patient proceeded directly to ITP as the potential risks of the trial outweighed the benefits.
Following ITP, there was a significant reduction in Ashworth scores (mean -14.64;p< 0.001), Penn scores (mean -2.92;p< 0.001), NRS for pain, comfort and spasticity(p< 0.001) and significant increases in PM at 5 LL joints (p< 0.01). Goals focussed on: ease of positioning (n=34), improved comfort (n=28), skin integrity (n=12), ease of personal care (n=33), pain (n=11), seating (n=17) and reduction of oral medications (n=23). All goals were achieved except 3 patients who did not achieve seating goal due to LL contractures.
ITP was well tolerated: adverse events included hypotension with intrathecal bupivicaine(n=9), myocardial infarction preventing treatment with ITP(n=1), infection(n=2), nausea(n=1).
16(35%) patients required repeat ITP after a mean interval of 11.4 months as spasticity and spasms returned.
Discussion: ITP is a highly effective option for severe LL spasticity, spasms and pain in appropriately selected patients with advanced MS.
Disclosure: Dr Sara Simeoni: nothing to disclose.
Elizabeth Keenan: nothing to disclose.
Katrina Buchanan: nothing to disclose.
Heesook Lee: nothing to disclose.
Corazon Padilla: nothing to disclose.
Dr Rachel Farrell has received honoraria / consultancy fees from Biogen Idec, Merck, TEVA Allergan PLC, Canbex Pharmaceuticals Ltd, GW Pharma. Dr Farrell's research is supported by the NIHR UCL Biomedical Research Centre.
Dr Valerie Stevenson: nothing to disclose.