514 - Overall Treatment Effectiveness Scale for Optimizing Botulinum Neurotoxin Injections for Spasticity Management

Spastic paraparesis and spastic quadriparesis.

 

Case Description:

The ability to document the typical two to six week maximum benefit after botulinum neurotoxins (BoNT) injections for spasticity has not been developed. We created a novel patient reported outcome tool, the Overall Treatment Effectiveness Scale (OTES), to capture the peak efficacy of BoNT injections. OTES is an 11-point scale ranging from –5 (worst) to +5 (best) where each week, for 12 weeks, the patient and/or caregiver rate the overall benefit and side effects of the injections on a flow sheet. Three patients utilized OTES to provide injection feedback. OTES ratings contributed to individualized adjustments in muscles, dosage, and dilution every three to four months over a two-year span. Following six to eight treatment cycles, all patients achieved sustained improvements rated at +4 /5 for 10–12 weeks, indicating successful optimization of BoNT injections through OTES.

Discussions: This series highlights the value of OTES as a clinical tool to track overall effectiveness of BoNT injections. OTES produces a structured approach to collecting weekly patient feedback and enables physicians to adjust muscles, dose, and dilution. The data captured through OTES generates a bell-shaped curve representing the magnitude and duration of therapeutic response, which aids in dose titration to achieve optimal clinical outcomes.

Conclusions: OTES is an effective clinical tool for optimizing BoNT injections for spasticity management. Future research will aim to validate the scale, improve integration into practice, and develop a digital application for patient and caregiver use.