Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force

Dirk Dressler, Roongroj Bhidayasiri, Saeed Bohlega, Abderrahmane Chahidi, Tae Mo Chung, Markus Ebke, L. Jorge Jacinto, Ryuji Kaji, Serdar Koçer, Petr Kanovsky, Federico Micheli, Olga Orlova, Sebastian Paus, Zvezdan Pirtosek, Maja Relja, Raymond L. Rosales, José Alberto Sagástegui-Rodríguez, Paul W. Schoenle, Gholam Ali Shahidi, Sofia TimerbaevaUwe Walter, Fereshte Adib Saberi

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


Botulinum toxin (BT) therapy is an established treatment of spasticity due to stroke. For multiple sclerosis (MS) spasticity this is not the case. IAB-Interdisciplinary Working Group for Movement Disorders formed a task force to explore the use of BT therapy for treatment of MS spasticity. A formalised PubMed literature search produced 55 publications (3 randomised controlled trials, 3 interventional studies, 11 observational studies, 2 case studies, 35 reviews, 1 guideline) all unanimously favouring the use of BT therapy for MS spasticity. There is no reason to believe that BT should be less effective and safe in MS spasticity than it is in stroke spasticity. Recommendations include an update of the current prevalence of MS spasticity and its clinical features according to classifications used in movement disorders. Immunological data on MS patients already treated should be analysed with respect to frequencies of MS relapses and BT antibody formation. Registration authorities should expand registration of BT therapy for spasticity regardless of its aetiology. MS specialists should consider BT therapy for symptomatic treatment of spasticity.

Original languageEnglish
Pages (from-to)112-120
Number of pages9
JournalJournal of Neurology
Issue number1
Publication statusPublished - 1 Jan 2017

Bibliographical note

Funding Information:
Dressler D: DD received honoraria for services provided to Allergan, Ipsen, Merz, Desitin, Syntaxin, Abbvie, Medtronic, St Jude, Boston Scientific, Almirall, Bayer, Sun, Teva, UCB, IAB-Interdisciplinary Working Group for Movement Disorders. He is shareholder of Allergan and holds patents on botulinum toxin and botulinum toxin therapy. Bhidayasiri R: RB is supported by Thailand Research Fund, Chulalongkorn Academic Advancement into its 2nd Century Project, and Ratchadapiseksompoj grant of Chulalongkorn University. He is an advisory board member of Britannia Pharmaceuticals; receives honoraria from Novartis, Ipsen, GlaxoSmithKline, and BL Hua pharmaceuticals; and royalties from Wiley-Blackwell and Humana press. He is an associate editor of BMC Neurology and Journal of Clinical Movement Disorder; and on the editorial board of Parkinsonism and Related Disorders journal and Journal of the Neurological Sciences. Bohlega S: SB has nothing to declare. Chahidi A: AC has nothing to declare. Ebke M: ME has nothing to declare. Jacinto J: JJ has received financial support from Ipsen, Allergan and Merz companies as an expert advisor, lecturer/speaker, researcher, peer trainer in the fields of spasticity management and neuro-rehabilitation. He owns no shares nor has any other relation with the above-mentioned companies. Kaji RE: RK received honoraria from Ipsen, GSK, Eisai and Merz to lecture in symposiums, and training courses and for advisory board participation. He participated in several clinical research trials from Merz. He holds a patent on A2NTX. Kanovsky P: PK has received speaker´s honoraria from Merz, Ipsen, Allergan, Medtronic, Novartis, AbbVie and Desitin. Micheli F: FM has nothing to declare. Orlova O: OO is scientific consultant for Allergan, Ipsen, Merz, MSD. Paus S: SP received honoraria for services provided from Allergan, Ipsen and Merz. Pirtosek Z: DP received compensation for speaker related activities from Pharmaswiss and Medis. Sagástegui-Rodríguez A: ASR has nothing to declare. Schoenle PW: PWS has nothing to declare. Shahidi GA: GAS has nothing to declare. Tae MC: MCT received honoraria from Ipsen, Allergan and Merz to lecture in symposiums, and in training courses and to participate in advisory boards. He participated in clinical research from Ipsen. He did not receive any research funding and has no financial interest in BoNT. Timerbaeva S: ST has received speaker fees and meeting sponsorship from Ipsen and Merz companies. Walter U: UW has received research funds from Merz Pharmaceuticals and speaker honoraria and travel grants from Abbvie, Bayer Vital, Ipsen Pharma, Merz Pharmaceuticals and Pfizer. Adib Saberi F: FAS received honoraria for services provided from Abbott, Abbvie, Almirall, Allergan, Bayer, Desitin, Dynamed, Ipsen, Medtronic, Merz, Sintetica, Sun, Teva and UCB.

Publisher Copyright:
© 2016, Springer-Verlag Berlin Heidelberg.

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology


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