Title : Improvement of the functional state of the brain in patients in disorders of consciousness as result of the treatment of generalized spasticity withincobotulinumtoxin A (Xeomin®)
Monitoring of patients with disorders of consciousness after coma with 18F FDG positron emission tomography (18F-FDG PET) revealed an improvement of consciousness and behavioral signs of awareness, as well as increases of regional metabolic activity after correction of generalized spasticity. These increases were detected in numerous yet different brain areas of different patients.
The aim of the current study was to identify changes of metabolic activity that are common for the entire group of patients and to estimate their relation to the improvement of consciousness, including higher brain functions.
We analyzed clinical data (muscle tone by modified Ashworth scale (MAS) and level of consciousness (Coma Recovery Scale–Revised, Loewenstein Communication Scale)) and 18F-FDG PET data of 25 patients with disorders of consciousness after coma (including permanent vegetative state) and generalized spasticity, who received “multipattern” botulinum toxin therapy with Xeomin (the total dose up to 1400 u). Clinical neurological assessment and 18F-FDG PET studies were conducted before the therapy and 3 weeks after that.
We found that clinical effects of botulinum toxin (reduction of muscle tone ≥1 MAS scores and improvement of consciousness, including higher brain functions) are associated with improvement of metabolic activity in brain areas maintaining movement as well as visual, auditory, and higher mental functions.
Taking into account the functional variability of neurons (S. Medvedev), blocking neuromuscular transmission in all spastic muscles with botulinum toxin therapy with Xeomin leads to a reduction of abnormal afferent and efferent hyperactivity of neuronal circuits, which releases the brain for other activities.
Audience take away:
The data we presented in this poster are valuable for a better understanding of the central effect of botulinum toxin therapy. These data may be useful for designing of future research and for teaching.