More news can be found in New Pathways Magazine, our bi-monthly publication, and also check daily at MSRC: Latest MS News.

Allergan Inc. announced that the United States Food and Drug Administration or FDA has approved BOTOX for treatment of increased muscle stiffness in the elbow, wrist and fingers in adults with upper limb spasticity.

Upper limb spasticity may occur following a spinal cord or traumatic brain injury or in patients affected by multiple sclerosis or adults with a history of cerebral palsy. FDA approved the drug to treat spasticity in flexor muscles, a condition that can result from stroke, brain injury or multiple sclerosis.

Source: RTT News © 2010 RTTNews (10/03/10)

Anjali Shah, MD, Assistant Professor, Divisions of Physical Medicine and Rehabilitation and Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, and colleagues reported on data from 19 patients whose spastic foot drop was treated with botulinum toxin type A injections.

Nearly 90% of MS patients report the presence of spasticity, and lower-extremity spasticity increases the energy of walking and aggravates fatigue, Dr. Shah pointed out. Oral antispasticity medications can exacerbate fatigue and decrease cognitive functioning.

Botulinum toxin type A injections focally target spasticity, and do not cause fatigue; there are, however, limited data on the use of such injections to specifically treat spastic foot drop due to plantar flexor spasticity in MS patients.

According to the study protocol, 150 units of botulinum toxin type A diluted in 1 cc of preservative-free saline were injected into the medial gastrocnaemius muscle, lateral gastrocnaemius muscle, and soleus muscle.

Electrical stimulation was used to localise the motor points in the target muscles.

Patients underwent 6 to 8 weeks of physical therapy.

Overall, 74.7% of patients have returned for repeat botulinum toxin type A injections.

Patient self-report surveys revealed improved ambulation with less tripping or toe drag, improved driving ability, and less fatigue.

Results document significant improvement in spasticity (P = .1) and emotional quality of life (P = .035).

Dr. Shah cautioned that the study was limited by small sample size and the use of varying physical-therapy programs between subjects.

[Presentation title: Botulinum Toxin in the Treatment of Spastic Foot Drop in Multiple Sclerosis: An Analysis of the Effects on Gait, Fatigue and Quality of Life. Abstract P03.070]

Source: Doctor's Guide (c) 1995-2008 Doctor's Guide Publishing Limited (18/04/08)

Bladder problems are a common and disabling symptom of MS where both storage and emptying processes can be disrupted. Incontinence is common and being unable to 'hold on' (known as urgency) is understandably considered by many people with MS to be one of the most troubling symptoms they face.

In the recent research, carried out at the National Hospital for Neurology and Neurosurgery, 43 people with MS who had severe incontinence problems were treated with botulinum neurotoxin type A (Botox (R)) bladder muscle injections. The action of the injection on the bladder is complex but its overall effect is to reduce involuntary contractions and so reduce frequency of urination and urgency.

The GBP200,000 study showed significant improvements in incontinence episodes and the frequency of urination both day and night. There were also sustained improvements in all quality of life measures used and frequency of urination returned to near normal.

Dr Laura Bell, Research Communications Officer for the MS Society, said: "Living with symptoms such as bladder problems can be extremely distressing and restrictive, but this type of treatment can make a tangible and substantial improvement to people's lives and we hope it will become part of standard care for people with MS who need it."

The typical duration of the effect of the treatment was 10 months and similar results were seen with repeat treatments.

This treatment is not yet licensed in the UK and is consequently not yet widely available for people with MS.

Professor Clare Fowler, Consultant in Uro-Neurology at The National Hospital for Neurology and Neurosurgery said: "This study was done as part of a research investigation and the treatment is not widely available. This is because bladder injections of Botox(R) have not yet been licensed and although studies by the pharmaceutical company are ongoing it will probably take a few more years.

"This research has been extremely valuable in establishing a clinical method, researching why the treatment works so very well, and providing an opportunity to demonstrate the minimally invasive injection technique to more than 60 visitors, mostly UK consultant urologists, who attended as observers."

Further clinical trials to ascertain its effect in people with MS are currently underway. More information about clinical trials can be found at http://www.clinicaltrials.gov 

Source: MS Society (27/11/07)

Dr. Christopher Smith, assistant professor of urology at BCM, said an international multi-center study using Botox® to treat these patients is currently ongoing. He will direct the BCM part of the study.

"People with spinal cord injuries or multiple sclerosis are particularly prone to developing overactive bladder because the normal nerve pathways between the bladder and brain become interrupted," said Smith. "In these conditions, the bladder becomes overactive leading to urinary symptoms of frequency, urgency and possibly incontinence."

Botox® is a commercial preparation of botulinum toxin A that works by preventing nerve impulses from reaching the muscle.

"Botox® is the most potent drug known to man," said Smith. "It's amazing how medicine can utilize such an agent for therapeutic benefit. If you focally inject it in small quantities within the bladder, one can reduce overactive bladder symptoms without side effects associated with oral medications."

Botox® is advantageous because it is a durable yet reversible treatment, with symptom relief lasting between six to 12 months.

"Before Botox®, the only option left for a patient with refractory overactive bladder symptoms was to undergo extensive abdominal surgery, using the intestines to enlarge the bladder. This treatment requires a prolonged recovery period and, for the most part, is considered irreversible," said Smith. "Patients often prefer the reversible and less invasive option of Botox® injection."

Past studies show the drug is effective, but results from treatment in more patients are needed.

Source: Baylor College of Medicine © 1998 - 2007 Baylor College of Medicine® (15/09/07)

Botulinum Toxin, commonly knows as Botox, can paralyse and kill if consumed in contaminated food. But it's now safely used, in a purified form, as a medicine to control certain conditions marked by involuntary muscle contractions. Spasticity: This is a condition that occurs after a stroke, in multiple sclerosis and cerebral palsy patients or those suffering from traumatic brain injuries. Muscles become overactive and tighten uncontrollably. These spasms cause pain and can prevent a person from moving normally.

HOW IT WORKS: Once in the body, the toxin binds to nerve endings at the point where the nerves join muscles. This prevents the nerves from signaling the muscles to contract. The result is weakness and paralysis in that muscle. Botox is not approved by the FDA to treat spasticity, but doctors can prescribe the medication if they think it will be helpful.

HOW LONG DOES IT LAST? The drug injections usually don't manifest symptoms of recovery until a few days after the injections. The effects are usually long-lasting, however, and depending on the amount and where it was injected; Botox therapy can last from four to eight months.

SIDE EFFECTS: Botox therapy is a safe and effective treatment when given in very small amounts by a qualified neurologist. Some patients experience temporary weakness in the group of muscles being treated. Flu-like symptoms develop in some, but doctors say it is rare.

Source: ABCChicago.com Copyright ©2007 ABC Inc., WLS-TV Chicago

Christopher Chapple, a visiting professor at Sheffield Hallam University, said poisonous botulinum toxin could be used therapeutically to treat bladder storage and sensation problems such as incontinence and cystitis. Professor Chapple, who is carrying out new research into the treatment at the University's Biomedical Research Centre, said it had successfully helped eighty per cent of cases during recent trials.

He explained in a lecture at Sheffield Hallam that a simple injection of the substance into the bladder lining could bring relief to some of the ten per cent of people in the UK who currently suffer from an overactive bladder, which is resistant to other drug therapy.

He said: "Doctors are now realising the role of the bladder lining as the cause of problems to do with frequent or painful passing of urine. By injecting the patient's bladder lining with botulinum toxin, we can block the release of nerve transmitter substances and sensory nerves, which means that the patient doesn't feel the need to go to the toilet as often. It also means we don't have to rely on intensive drug therapy, or invasive surgery.

"Around ten per cent of the current UK population has an overactive bladder, while nearly a third of us will experience bladder storage or sensation problems at some point in our lives.

"The bladder normally stores urine at a low pressure, until it can be passed at a socially acceptable time, but some people have problems storing urine and need to go frequently, and urgently. Problems can occur with age, or sometimes as the result of a neurological disorder such as multiple sclerosis.

"Imagine you've come home after a few drinks, you need to pee, and you're fumbling to get the key in the door - that's the sensation some of these people experience every day."

He added: "Treatment with botulinum toxin has been successful in eighty per cent of cases so far. Work is still ongoing, but there is no doubt that it is a major advance that will really improve sufferers' quality of life."

Botulinum toxin, commercially known as Botox, is highly toxic, but is used in minute doses to control muscle spasms. Demi Moore and Madonna have reportedly benefited from its cosmetic, wrinkle-softening effects.

The simple bladder lining treatment lasts between three and six months, and can be administered to outpatients under local anesthetic.

Around fifty people have currently been treated with the botulinum toxin treatment. Professor Chapple and his team are now involved in clinical trials, and will publish further findings at the end of the current, 18-month long research project.

Professor Chapple has a specialist interest in reconstructive surgery and is also working on engineering tissue to carry out urethral reconstruction. Other research is ongoing in the research group to investigate the underlying problems behind bladder and prostate problems.

Christopher Chapple is a Consultant Urological Surgeon at the Royal Hallamshire Hospital, part of Sheffield Teaching Hospitals NHS Trust.

He spoke at Sheffield Hallam University on Wednesday 21 February, 2007.

Source: News-Medical.Net©2007 News-Medical.Net (21/02/07)