key: cord-0978394-886vu9t4
authors: Branquinho, Lurdes Rovisco; Fonseca, João Pedro; Amaral, Carla; Tão, Maria Joaquim
title: Spasticity treatment with botulinum toxin during the COVID-19 pandemic
date: 2021-01-31
journal: Toxicon
DOI: 10.1016/j.toxicon.2020.11.359
sha: e331df791d2737ce61da04a8c54a9398707301a2
doc_id: 978394
cord_uid: 886vu9t4

nan

Introduction and Objectives: Intramuscular botulinum toxin type A (BoNT-A) is an effective treatment for focal spasticity. Since the coronavirus disease 2019 outbreak, all deferrable clinical activities have been suspended or postponed for several months worldwide. This monocentric, observational, cross-sectional study aims to investigate the impact of the COVID-19 pandemic on treatment of spasticity with BoNT-A in adult patients. Methods: This study examined the BoNT-A spasticity treatments scheduled at a central hospital in the first six months of the COVID-19 outbreak in Portugal. We analyzed how many appointments were suspended and the extent of the delay of those that were rescheduled. Also, we compared the number of treatments that took place in that period with the number during the previous year. Results: In the first three months of the COVID-19 outbreak, all scheduled treatments were either suspended or rescheduled. After that, there was a progressive return of the treatments, starting with the rescheduled ones (n¼23) that took place with 2 to 6 months of delay. There were also some patients who missed their appointments (n¼7) or that were discharged due to clinical reasons (n¼12). By the end of the first semester, the total number of treatments, although with no immediate side effects noted, was about 50% less than the previous year. Conclusions: The reorganization of non-urgent clinical activities that occurred due to the COVID-19 pandemic led to the interruption or delay of spasticity treatments. In the present study, the first three months had more repercussions, with a complete suspension of treatments, that were partially recovered in the second trimester. All the treatments that took place in the first semester had no immediate complications recorded, which is a good preliminary indicator of the safety of BoNT-A treatment during the COVID-19 outbreak, but further studies are needed. Keywords: Botulinum toxin; COVID-19; Pandemic; Spasticity PREGNANCY OUTCOMES FOLLOWING EXPOSURE TO ONABOTULINUMTOXINA UPDATE: 29 YEARS OF SAFETY OBSERVATION Introduction and Objectives: The safety of onabotulinumtoxinA during pregnancy remains an important topic for healthcare providers and their patients. This analysis evaluated pregnancy outcomes following onabo-tulinumtoxinA exposure to provide a cumulative 29-year update. Methods: The Allergan Global Safety Database contains reports of ona-botulinumtoxinA administration before/during pregnancy, including prospective (reported before outcome known) and retrospective (outcome known when reported) cases. The database was searched (1/1/90-12/31/ 18) for eligible cases where treatment occurred during pregnancy or 3 months prior to conception. To minimize reporting bias, prevalence rates for overall and major birth defects were estimated from prospective cases of live births only. Results: Of 913 pregnancies, 397 (43.5%) were eligible with known outcomes. Maternal age was known in 215 cases, with 45.6% of mothers 35 years. Indication was known in 340 cases, with the most frequent being cosmetic (35.3%), migraine/headache (30.3%), and movement disorders (12.1%). OnabotulinumtoxinA dose information was known in 242 cases: 32.2% <50 U, 11.2% 50 U to <100 U, 40.1% 100 U to <200 U, and 16.5% 200 U. Of 195 prospective pregnancy cases with 197 fetuses, there were 152 (77.2%) live births and 45 (22.8%) fetal losses (32 spontaneous abortions, 13 elective abortions). Of the 152 live births, 148 (97.4%) had normal outcomes and 4 had abnormal outcomes. Among the 4 abnormal outcomes, there were 1 major birth defect, 2 minor fetal defects, and 1 birth complication. The prevalence rate for overall fetal defects was 2.6% (4/152, 95% CI: 1.0-6.6%) and 0.7% (1/152, 95% CI: 0.1-3.6%) for major fetal defects (3%-6% in the general population). Conclusions: This 29-year retrospective analysis of safety data in onabo-tulinumtoxinA-exposed mothers demonstrated that the prevalence rate of

Toxicon 190 (2020) S10

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Appendix: Italian Botulinum Toxin Network Safe Infiltration Project participants