ARTICLE IN PRESS

Abstracts Toxins 2008 / Toxicon 51 (2008) 1–5436

effect size of reduction in spasticity or pain using a mixed-effect model and Pearson’s r.

Results: From 243 spasticity studies in the initialsearch, 7 fulfilled the criteria: 3 studies used botulinumtoxin, 2 cannabinol, and 1 each baclofen and tizanidine.Mean effect sizes were 0.49 (SD ¼ 0.41) and 0.31(SD ¼ 0.31) for decreases in spasticity and pain, respec-tively. The difference in effect size between spasticity andpain was insignificant (P ¼ .106). Pearson’s r was 0.49(P ¼ .072) between decreases in spasticity and pain.

Conclusions: Treatment of spasticity resulted in asimilar effect size for reduction in spasticity and pain.There was also a trend that suggests correlation betweenchange reduction for spasticity and pain.

Keywords: Botulinum toxin; Pain; Spasticity

10.1016/j.toxicon.2008.04.107

106. Motor disorders: Evidence-based review of the useof botulinum toxins

David SimpsonMount Sinai School of Medicine, New York, USA

Botulinum neurotoxin (BoNT) has emerged as amajor therapeutic advance in the treatment of manydisorders, affecting motor and non-motor systems. It hasapplications in numerous medical specialties, includ-ing neurology, rehabilitation medicine, ophthalmology,otolaryngology, gastroenterology, orthopedics, dermatol-ogy, and urology. The use of BoNT for pain disorders is anemerging and active area of interest.

A task force of the Technology and TherapeuticsAssessment Committee of the American Academy ofNeurology performed a literature search for relevant, fullypublished, peer-reviewed articles related to clinical use ofBoNT for neurological disorders. The panel was comprisedof specialists with experience in the therapeutic use ofBoNT for the indications under consideration or withexpertise in guideline methodology. Authors reviewed,abstracted, and classified papers based on AAN criteria(Class I–IV). This lecture summarizes the evidencesupporting the use of BoNT in neurological disorders,including adult and childhood spasticity and selectedmovement disorders.

Keywords: Botulinum toxin; Movement disorders; Spasticity; Evidence-

based review

10.1016/j.toxicon.2008.04.108

107. Botulinum toxin in treatment of axial dystonia

Vladana Spica, Marina Svetel, Igor Petrovic,Vladimir KosticInstitute of Neurology, Belgrade, Serbia and Montenegro

Axial dystonia is characterized by contraction of thetrunk musculature, which causes abnormal trunk posture,and myoclonic motor activities may be superimposed.

Local treatment with botulinum toxin is the first choicetherapy in many types of dystonia. Other types oftreatment, chosen depending on primary disorder thatcaused axial dystonia, have shown to be of little or noeffect, and there are studies showing that Botulinum toxininjections could be useful in controlling some types ofaxial dystonia.

We treated five of our patients with different diagnoses(Parkinson’s disease, Hallervorden–Spatz disease, Leighdisease and two with generalized dystonia, one of themwith proven DYT 1 mutation and the other idiopathic)who had axial dystonia as a prominent symptom non-responsive to pharmacological measures (levodopa,baclofen, clozapine). Also, this was the symptom thatthey found most disabling, preventing them from beingindependent in everyday life. We applied Botulinum toxinin paraspinous muscles in average doses of 200 Dysport Uin 7–8 spots. Improvement of their symptoms wasevaluated at baseline and 2 weeks after injection and onthe basis of video taping and their subjective assessmentof capability for daily activities. All reported to haveimprovement to some extent, but of varying duration andlevel.

Keywords: Axial dystonia; Botulinum toxin

10.1016/j.toxicon.2008.04.109

108. Long-term effects of botulinum toxin Ain a cerebral palsy cohort

Kristina Tedroff a, Fredrik Granath b, Hans Forssberg a,Yvonne Haglund-Akerlind c

a Neuropediatric Unit, Department of Woman and Child Health, Karolinska

Institutet, Stockholm, Swedenb Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet,

Stockholm, Swedenc Pediatric Orthopedic Unit, Astrid Lindgren Children’s Hospital, Department

of Woman and Child Heath, Karolinska Institutet, Stockholm, Sweden

In a prospective cohort study we investigated the long-term effects of BTX-A treatment in children with CP,mainly if the effect on muscle tone and joint range ofmotion (ROM) remain after repeated injections overseveral years.

94 children with CP receiving BTX-A to the lowerextremities were followed for a median of 562 days. Thelongest follow-up time was 3.6 yr and included a max-imum of 8 inj./muscle.

50% of the patients had spastic diplegic, 22% hemi-plegic, 25% tetraplegic and 3% dyskinetic CP. The GMFCSlevel was I in 29%, II in 15%, III in 16%, IV in 17% and V in23% of the patients. Median age at first injection was5 yr 4mo. Adductor, Hamstring and Gastrosoleus muscleswere given 785 BTX-A injections.

Outcome measurements were muscle tone (ModifiedAshworth scale) and ROM. Assessments were made beforeevery injection, 3–6 weeks after and then at 90-dayintervals. Also, the effect before and after repeatedinjections to M gastrocnemius were analyzed. Non-parametric statistics were used to identify significantchanges as compared to baseline.