Impact of Botulinum Toxin Consultation Shutdown Due to the Covid-19 Pandemic on Spasticity Treatment: A Review of the Literature

Introduction: The COVID-19 pandemic has imposed an additional pressure on health systems worldwide, creating an increased challenge to chronic patient management due to consultation shutdown. Spastic patients were especially vulnerable to inadequate care. This review aims to describe the impact of botulinum toxin (BT) consultation interruption due to the COVID-19 pandemic on spasticity treatment. Methods: A literature search was conducted in the database of Medline, PubMed, Embase, Google Scholar and Scopus. Keywords for the search included “COVID-19” AND “Botulinum Toxin” AND “Spasticity”. Results: A total of 6 studies reporting the impact of BT consultation suspension on spasticity due to the COVID-19 pandemic met inclusion criteria. All studies were observational and included a small sample. Consultation interruption was variable between studies and ranged from 36-75 days, originating a mean treatment delay of 23-129 days due to re-scheduling difficulties. The majority (72-93%) of patients in all studies perceived worsening of spasticity with BT consultation suspension. Effects seem to be worse with longer treatment delays and concerning the mobility and passive function treatment objectives. Some studies reported a worse quality of life in patients with BT treatment delay whilst others did not find this association. Discussion: Although a year has passed since the start of the COVID-19 pandemic, there is a scarcity of studies reporting the impact of BT consultation interruption on the treatment of spastic patients. An increased inter-treatment delay originates a reduction in the effectiveness at the end of the treatment cycle due BT washout. On average, a 1% worsening of symptoms occurs with one day of delay. Thus, a small delay of a few weeks can lead to worsening of symptoms which may take several treatment cycles to return to previous stable benefit level. The impact of BT consultation suspension on quality of life is controversial and further studies are necessary to clarify this question. Conclusions: The COVID-19 pandemic has had a major negative impact on the BT treatment of spasticity. Thus, consultation shutdown severely affected these patients and needs to be avoided.