Joan Largent

The impact of spasticity severity on healthcare utilization among MS patients: A large-scale six-year follow-up study

OBJECTIVE: To assess the association of spasticity and healthcare utilization (HCU) among North American Research Committee on Multiple Sclerosis (NARCOMS) registry participants. BACKGROUND: Over 80% of multiple sclerosis (MS) patients ultimately experience spasticity. Spasticity is associated with fatigue, pain, impaired mobility and lower quality of life. The impact of spasticity on HCU is poorly understood. DESIGN/METHODS: NARCOMS maintains a self-report database of MS patients who volunteer health-related information through online or paper questionnaires at enrollment and semi-annually thereafter. Among 5172 individuals who completed surveys in 2005 and 2011, we evaluated the association of HCU with spasticity reported using the 5-point Performance Scales spasticity subscale (PSss). RESULTS: Responders were predominantly female (76.2%) and white (96.2%). In 2005 their mean (SD) age was 52 (9.8) years, disease duration 13.7 (9.1) years, and 50.8% were able to walk unassisted. 18.8% reported no spasticity, 36.2% minimal, 17.5% mild, 15.7% moderate, 9.9% severe and 1.9% total spasticity. In the prior 6 months, 653 (13.2%) reported an ER visit while 358 (7.1%) reported a hospitalization. Frequencies for both increased with spasticity severity (p<0.001 for linear trend). Over 6 years, PSss improved or remained stable in 74.9% and worsened in 25.9%. As compared to participants whose PSss score worsened, those with improved spasticity were less likely to report an ER visit (OR 0.83; 95%CI: 0.67-1.03) or a hospitalization (OR 0.76; 95%CI: 0.59-0.99) even after accounting for disability and sociodemographic factors. CONCLUSIONS: More severe and worsening spasticity is associated with greater HCU, emphasizing the adverse impact of spasticity. Study Supported by: NARCOMS is supported in part by the Consortium of Multiple Sclerosis Centers (CMSC) and this study by Allergan, Inc. Disclosure: Dr. Tyry has nothing to disclose. Dr. Salter has received personal compensation for activities with GlaxoSmithKline Inc. as a consultant. Dr. Largent has received personal compensation for activities with Allergan Inc. as an employee. Dr. Largen holds stock and/or stock options in Allergan Inc. Dr. Marrie has received research support from the Canadian Institutes of Health Research, Multiple Sclerosis Society of Canada, Consortium of MS Centers, and Sanofi-Aventis Pharmaceuticals, Inc.

Poster 66: The Adult Spasticity International Registry (ASPIRE) Study: Treatment Utilization Patterns in Patients Treated for Both Upper and Lower Limb Spasticity

hemiparetic subjects who received abobotulinumtoxinA (Dysport , aboBoNT-A) in both UL and LL simultaneously. Design: Phase-III, open-label (OL) study (NCT01251367). Setting: 52 centres;11 countries worldwide. Participants: Eligible subjects previously completed double-blind (DB) placebo-controlled study (NCT01249404). Interventions: DB: aboBoNT-A 1000U or 1500U in LL for one treatment cycle (TC). OL: repeated injections (up to 4 TC) performed over max18 months. Subjects received aboBoNT-A 1500U in LL for TC1/TC2; from TC3 subjects could receive up to 500U in UL, providing total aboBoNTA dose did not exceed 1500U. Main Outcome Measures: Ten-meter comfortable barefoot walking speed. Results: Of 352 subjects, 63 received co-injection in LL+UL at both TC3/TC4, and 64 received injection in LL only. Mean (SD) aboBoNT-A doses in LL at TC3 and TC4 were 1380U (210) and 1360U (220), respectively, in subjects injected in LL only, and 1000U (50) and 1000U (50), respectively, for subjects injected in LL+UL. At baseline, tenmeter comfortable barefoot walking speed (mean [SD]) was similar in subjects injected in LL+UL (0.42 [0.20]) and LL only (0.42 [0.20]). At TC3 Wk4, both subgroups had improvements from baseline (mean change [SD]: LL+UL: 0.063 [0.131]; LL only: 0.078 [0.114]), which further improved to TC4 Wk4 ( LL+UL: 0.086 [0.166]; LL only: 0.086 [0.123]). Conclusions: In subjects with spastic paresis requiring concurrent treatment of UL and LL, it was possible to split 1500U total dose of aboBoNT-A between both extremities while still improving walking speed similarly to that observed in subjects injected in lower extremities only. This provides important information for the treatment of LL and UL simultaneously with aboBoNT-A in adult patients with hemiparesis. Level of Evidence: Level I

Poster 281 The Adult Spasticity International Registry (ASPIRE Study): Baseline Demographics and Clinical Characteristics of Patients Treated for Spasticity

Disclosures: Joel Castellanos: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 32-year-old right-handed woman with metastatic malignant mixed Mullerian tumor (MMMT) presented with left upper extremity numbness, tingling, and pain along her posterior forearm, thumb, and second digit. She developed mild symptoms during pregnancy 7 months prior, and severe symptoms three months before presentation after receiving carboplatin and paclitaxel chemotherapy for MMMT. Four years earlier, she also experienced a milder form of these symptoms; electromyography (EMG) found no abnormalities and the symptoms resolved spontaneously. Of note, her history is significant for numerous left shoulder subluxations requiring reduction. Setting: Outpatient cancer rehabilitation clinic. Results: Physical examination revealed decreased strength in left elbow extension (4-/5) and wrist extension (4/5), absent left triceps reflex, and diminished pinprick sensation over the posterior forearm with increased sensitivity to light touch over the distal radial nerve distribution. Computerized tomography of her neck and chest did not reveal neural foraminal narrowing or metastatic disease to explain her symptoms. On EMG testing, radial sensory nerve conduction studies (NCS) were not recordable, and radial motor studies at the forearm showed decreased amplitude compared to the right side (1.7mV vs 3.7mV) with comparable distal latencies. Median and ulnar motor and sensory NCS were normal. Needle electromyography revealed positive waves, fibrillations, and chronic changes in the extensor carpi radialis brevis, brachioradialis, and extensor indicis, but not the triceps, suggesting an incomplete chronic axonal neuropathy proximal to the brachioradialis. Deltoid, biceps brachii, pronator teres, and first dorsal interosseus (hand) had no abnormal EMG findings. Discussion: Repetitive shoulder subluxation likely created tension on the radial nerve at the spiral groove of the humerus, causing a stretch injury. Ligamentous laxity in pregnancy caused symptoms to recur, and chemotherapy worsened the injury to the point of axonotmesis. Conclusions: Pregnancy may exacerbate neuropathies associated with ligamentous laxity, and chemotherapy can worsen pre-existing neuropathies. Level of Evidence: Level V