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Subject: BoNT-A is Superior to Tizanidine for Upper Extremity Spasticity (AAN 2007) Date: 5/10/2007 E-MOVE reports from the 59th annual meeting of the American Academy of Neurology. Poster, Session, and page numbers below refer to those published in the on-site late-breaking abstracts guide. Botulinum neurotoxin vs. oral tizanidine in the treatment of upper extremity spasticity: A double-blind, placebo-controlled study DM Simpson, JM Gracies, SA Yablon, R Barbano, A Brashear, BoNT/Tizanidine Study Group SLB.003; 8 Botulinum toxin type A (BoNT-A) as Botox reduces muscle tone and improves cosmesis more than tizanidine with fewer adverse effects, according to this double-blind, placebo-controlled trial. Sixty patients with upper extremity spasticity due to traumatic brain injury were randomized to receive one of three treatments: a single injection of up to 500 U BoNT-A to the wrist flexors with or without other UE muscles, plus oral placebo; oral tizanidine titrated according to the prescribing information up to a maximum of 36 mg/day, plus injected placebo; or double placebo. Patients were evaluated over the course of 18 weeks. The primary outcome measure was change in the Modified Ashworth Score for the wrist flexors. The mean BoNT-A dose injected was 393 U; the highest mean tizanidine dose achieved was 20 mg/day, which fell by week 18 due to drop-outs. At both weeks 3 and 6, the change in MAS was greatest for BoNT-A, next greatest for placebo, and least for tizanidine (week 3: p<0.02 for BoNT-A vs. placebo and vs. tizanidine; week 6: p<0.02 for BoNT-A vs. tizanidine, NS vs. placebo). Cosmesis as measured on the Disability Assessment Scale was significantly greater for BoNT-A at week 6. Adverse effects due to tizanidine were significantly higher that either BoNT-A or placebo. The study was supported by Allergan, Inc. E-MOVE Editor: Richard Robinson, NASW, WE MOVE
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