Combined Botox & physio treatment success

Improvement in spasticity and quality of life


18 adults with various types of HSP (50/50 male:female) but all requiring mobility aids showed improvement in:

  • muscle tone/reduced spasticity

  • walking speed and endurance

  • pain and quality-of-life.

Scores on the Spastic Paraplegia Rating Scale were significantly reduced after treatment and maintained when measured at both one and three months after treatment.


Participants in this Italian study received pinpoint accurate Botox injections, mainly in the hamstrings, the large mid-thigh muscle (rectus femoris) and the calf muscles followed by intensive physiotherapy.



Introduction: The Hereditary Spastic Paraplegia (HSP) is a heterogeneous group of neurodegenerative disorders characterized by progressive spasticity and lower limbs (LL) weakness. There is no treatment to cure or halt the disease, except for symptomatic therapy. The use of botulinum toxin type A (BoNT-A) is one of the primary treatment for focal spasticity. Physiotherapy (PT) can help in maintaining residual functioning. We performed a retrospective study to evaluate the effect of the combined BoNT-A and intensive PT in patients with HSP.

Methods: Eighteen adult patients (50% females) with clinical diagnosis of HSP were recruited. Eleven patients had a genetic diagnosis of SPG4, 5, 7, 8, 11, 72. Patients were all autonomously deambulant or needed support. BoNT-A was injected in 36 LL in different spastic muscles under electromyographic guidance and followed by intensive PT sessions. Outcome measures included disease severity, motor functional measures, perceived pain self-report and quality of life. Assessments occurred at baseline, 1 and 3 months after BoNT-A injection.

Results: Most inoculated muscles were hamstrings, rectus femoris and gastrocnemius. We observed an improvement in muscle tone, in the gait velocity and distance length. Spastic Paraplegia Rating Scale was significantly reduced after treatment, in addition to improving pain and quality of life. These results were re-confirmed in 3 months time.

Conclusion: Our study indicates that combined treatment of BoNT-A and PT can lead to improvement of spasticity and quality of life in patients with HSP.


SOURCE: Front Neurosci. 2020 Feb 21;14:111. doi: 10.3389/fnins.2020.00111. eCollection 2020. Copyright © 2020 Paparella, Vavla, Bernardi, Girardi, Stefan and Martinuzzi. PMID: 32153352


Efficacy of a Combined Treatment of Botulinum Toxin and Intensive Physiotherapy in Hereditary Spastic Paraplegia


Gabriella Paparella 1Marinela Vavla 1 2Lisa Bernardi 1Giulia Girardi 1Cristina Stefan 1Andrea Martinuzzi 1 2

1 Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy.

2 Severe Developmental Disabilities Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Italy.

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