Spasticity treatment with botulinum toxin during the COVID-19 pandemic

Abstract

Introduction and Objectives: Intramuscular botulinum toxin type A (BoNT-A) is an effective treatment for focal spasticity. Since the coronavirus disease 2019 (COVID-19) outbreak, all deferrable clinical activities have been suspended or postponed for several months worldwide. This monocentric, observational, cross-sectional study aims to investigate the impact of the COVID-19 pandemic on treatment of spasticity with BoNT-A in adult patients. Methods: This study examined the BoNT-A spasticity treatments scheduled at a central hospital in the first six months of the COVID-19 outbreak in Portugal. We analyzed how many appointments were suspended and the extent of the delay of those that were rescheduled. Also, we compared the number of treatments that took place in that period with the number during the previous year. Results: In the first three months of the COVID-19 outbreak, all scheduled treatments were either suspended or rescheduled. After that, there was a progressive return of the treatments, starting with the rescheduled ones (n=23) that took place with 2 to 6 months of delay. There were also some patients who missed their appointments (n=7) or that were discharged due to clinical reasons (n=12). By the end of the first semester, the total number of treatments, although with no immediate side effects noted, was about 50% less than the previous year. Conclusions: The reorganization of non-urgent clinical activities that occurred due to the COVID-19 pandemic led to the interruption or delay of spasticity treatments. In the present study, the first three months had more repercussions, with a complete suspension of treatments, that were partially recovered in the second trimester. All the treatments that took place in the first semester had no immediate complications recorded, which is a good preliminary indicator of the safety of BoNT-A treatment during the COVID-19 outbreak, but further studies are needed. Keywords: Botulinum toxin; COVID-19; Pandemic; Spasticity