key: cord-0982225-lb3e5t27
authors: Ferreira, Eduardo Freitas; Neves, Ana Filipa; Portugal, Diogo; Silva, Nuno; Peixoto, Catarina; Matos, Catarina; Vera-Cruz, Carla; Cadete, Ana; Prates, Leonor
title: Impact of botulinum toxin consultation interruption due to the COVID-19 pandemic on ADULT PATIENT WITH DYSKINETIC CEREBRAL PALSY patients' perceptions of therapeutic goals
date: 2021-01-31
journal: Toxicon
DOI: 10.1016/j.toxicon.2020.11.390
sha: 19cb2534717d4ab86aea6ae24bf1070ce0d476c7
doc_id: 982225
cord_uid: lb3e5t27

nan

Introduction and Objectives: The COVID-19 pandemic has imposed an additional pressure on health systems worldwide, creating an increased challenge to chronic patient management due to consultation shutdown. 1 Spastic patients were especially vulnerable to inadequate care, resulting in a worsened quality of life. 2 This study aims to evaluate the impact of a 10week consultation interruption due to the COVID-19 pandemic on the patients' perceptions of spasticity evolution and therapeutic goals with botulinum toxin (BT) therapy. Methods: A cross-sectional study of patients with spasticity followed in the BT clinic at a physical medicine and rehabilitation department who had their consultation delayed due to the COVID-19 pandemic shutdown (March to May 2020). A standardized questionnaire was administered to all patients. Goal Attainment Scaling (GAS) was done for each previous BT treatment goal and patients' perceptions regarding the impact of treatment delay on their spasticity was evaluated using a Likert scale. Results: A total of 29 patients had their consultation delayed. One patient died during the follow-up period and was excluded from the analysis. The mean patient age was 65.3±11.7 years and the majority were male (57.1%; n¼16). Mean disease duration was 8.9±5.5 years,and the majority of patients had a stroke diagnosis (82.1%; n¼23) and a spastic hemiparesis (85.7%; n¼24). Eighteen patients were usually treated with abobotuli-numtoxinA (611.9±275.7 U) while 10 were treated with onabotuli-numtoxinA (215.0±83.1 U). Treatment objectives defined according to the World Health Organization's International Classification of Functioning, Disability and Health 3 included mobility facilitation (71.4%; n¼20), improved passive function (53.6%; n¼15), involuntary movement control (35.7%; n¼10), pain control (21.4%; n¼6), maintenance of range of motion (ROM) (10.7%; n¼3), and improved active function (10.7%; n¼3). The majority of patients (92.9%) presented an expected or greater outcome regarding their previous BT GAS assessment ( Table 1 ). The mean GAS outcome T-score was 52.1±5.1, and the mean change in GAS score was 11.2±6.3. BT administration was delayed by 4.3±1.6 months, with a mean inter-treatment period of 8.8±2.2 months. Twenty-four patients (85.7%) reported worsening of symptoms at the time of consultation delay (90% -mobility; 83.3% -pain; 80.0% -involuntary movement; 100.0% -ROM maintenance; 100.0% -passive function; 100.0% -active function). Some patients (35.7%; (n¼10) made up for the absence of BT administration with physiotherapy, 7.1% (n¼2) with oral antispastic medication, and 7.1% (n¼2) with increased orthosis usage, although the majority (57.1%; n¼16) adopted no additional adjuvant strategy. In patients reporting a "much worse" impact on mobility and passive function, the median treatment delay was higher (4.7 vs 4.1 and 4.5 vs 3.0 months, respectively) than in patients reporting a "worse" impact. Conclusions: The COVID-19 pandemic has had a major negative impact on the BT treatment of spasticity, even in patients treated with not very high doses. Consultation shutdown resulted in a treatment delay of 4 months, with the worsening of patient symptoms. As expected, effects seemed to be worse with longer treatment delays. The delay period was greater than shutdown duration due to rescheduling availability. Thus, consultation shutdown severely affected these patients and needs to be avoided. Keywords: Botulinum Toxin; Coronavirus; COVID-19; Spasticity

Delay in onabotulinumtoxinA treatment during the COVID-19 pandemic-perspectives from a virus hotspot

Botulinum toxin therapy in the SARS-CoV-2 pandemic: patient perceptions from a German cohort

World Health Organization. International classification of functioning, disability and health: ICF

E-mail address: joaopfonseca58653@gmail.com * Corresponding author: Department of Physical Medicine and Rehabilitation

Introduction: Spasticity has many associated symptoms that must be recognized and properly treated. Spasticity-related pain is one of them, and it is considered a major therapeutic challenge. It can be treated with the use of a vast number of pharmacological agents, including botulinum toxin. There is some evidence suggesting that botulinum toxin is effective