Bo Biering-Sørensen, Valerie L. Stevenson, Djamel Bensmail, Klemen Grabljevec, Mercedes Martínez Moreno, Elke Pucks-Faes, Joerg Wissel, Mauro Zampolini
Department of Neurology, Spasticity Clinic Rigshospitalet Glostrup, Valdemar Hansens Vej 7, Glostrup, Denmark. E-mail: bo.biering-soerensen@regionh.dk
DOI: 10.2340/16501977-2877

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Objective: To develop an algorithm for the selection of adults with disabling spasticity for treatment with intrathecal baclofen (ITB) and/or botulinum toxin type A (BoNT A).
Methods: A European Advisory Board of 4 neurologists and 4 rehabilitation specialists performed a literature review on ITB and BoNT A treatment for disabling spasticity. An online survey was sent to 125 physicians and 13 non-physician spasticity experts. Information on their current clinical practice and level of agreement on proposed selection criteria was used to inform algorithm design. Consensus was considered reached when ≥75% of respondents agreed or were neutral.
Results: A total of 79 experts from 17 countries completed the on-line survey (57%).
Agreement was reached that patients with multi-segmental or generalized disabling spasticity re-fractory to oral drugs are the best candidates for ITB (96. 1% consensus), while those with focal/segmental disabling spasticity are ideal candidates for BoNT A (98. 7% consensus). In addition the following are good candidates for ITB (% consensus): bilateral disabling spasticity affecting lower limbs only (97. 4%), bilateral (100%) or unilateral (90. 9%) disabling spasticity affecting lower limbs and trunk, and unilateral or bilateral disabling spasticity affecting upper and lower extremities (96. 1%).
Conclusion: This algorithm will support the management of adult patients with disabling spas-ticity by aiding patient selection for ITB and/or BoNT A treatments.

Involuntary muscle overactivity or spasticity is the increase in muscle tone caused as a consequence of a brain or spine lesion. The muscle overactivity can become disabling spasticity and adequate treatment or combination of treatments are essential to reduce or eliminate the problems and disability caused by the involuntary muscle overactivity. An European expert consensus on the treatment of disabling spasticity, with Intrathecal Baclofen (an implanted pump that delivers baclofen directly near the spinal cord) or injection of Botulinum Toxin into muscles, was made using an online survey with 79 experts completing the survey. This algorithm supports the future management of adult patients with disabling muscle overactivity by aiding patient selection for Intrathecal Baclofen and/or Botulinum Toxin treatment.