Impact of Short Term OnabotulinumtoxinA Treatment on Dependency and Cost-of-Care in Patients with Spasticity Secondary to Upper Motor Neuron Syndrome

Background: Central nervous system injury or neurodegenerative disease with associated upper motor neuron damage often produces spasticity, with patients having physical disability, pain, and limitations in their ability to perform activities of daily living. Objective: This open-label, non-randomized trial of adult outpatients with spasticity evaluated the impact of a single injection of onabotulinumtoxinA (BOTOX®, Allergan, Inc.) compared to a wait-listed control group on caregiver dependency, cost, and pain scores. Methods: A convenience sample of 67 patients participated in the study. 42 patients (mean age 50.8 ± 18.85 years) in a multidisciplinary outpatient adult spasticity management clinic received a single injection of onabotulinumtoxinA plus standard care. 25 age-matched (mean age 50.54 ± 18.38 years) wait-listed controls received standard care. At month 1 and 3 follow-up visits, surveys to assess dependency, cost, and pain were administered. Results: Of the 67 patients, 7 (2 treatment group and 5 wait-listed group) were lost to follow-up. The average dose of onabotulinumtoxinA administered was 420 U (range 100 to 600 U). The 38 onabotulinumtoxinA-treated patients exhibited statistically significant improvements in their degree of dependency (8.23 hour per week reduction in caregiver assistance [p=0.001]), their community cost subscale (decrease of $157 per week [p=0.001]), and pain (5.2 point reduction [p=0.017]). Wait-listed control group subjects exhibited no significant changes. Conclusions: These findings suggest that a single injection of onabotulinumtoxinA plus standard care produces significant improvements in caregiver dependency, cost, and pain in adults with spasticity due to upper motor neuron syndromes. A larger well-controlled, randomized, study is warranted.