{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:52:27Z","timestamp":1783011147533,"version":"3.54.6"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>One of the aims of diagnostic nerve blocks is to identify the overactive muscles that lead to a specific spasticity pattern. However, to date, there is no evidence on how nerve blocks may affect botulinum neurotoxin-A (BoNT-A) dose in patients with spasticity. This case-control study aims to assess the role of diagnostic nerve block in defining BoNT-A starting dose at first treatment. Patients with upper and lower limb spasticity treated for the first time with BoNT-A were retrospectively divided into two groups: Group 1 (n = 43) was evaluated with clinical assessment and diagnostic nerve block; Group 2 (n = 56) underwent clinical assessment only. Group 1 was injected with higher BoNT-A doses in some muscles (i.e., flexor digitorum profundus, soleus), and received a higher BoNT-A cumulative dose with a larger number of injected muscles for some spasticity patterns (i.e., \u201cclenched fist\u201d, \u201cflexed fingers\u201d, \u201cadducted thigh\u201d). Diagnostic nerve block may help the clinician to optimize and personalize the BoNT-A dose since the first BoNT-A treatment.<\/jats:p>","DOI":"10.3390\/toxins16090388","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T11:53:11Z","timestamp":1725623591000},"page":"388","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Do Diagnostic Nerve Blocks Affect the Starting Dose of Botulinum Neurotoxin Type A for Spasticity? A Case-Control Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5930-5974","authenticated-orcid":false,"given":"Mirko","family":"Filippetti","sequence":"first","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy"},{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, ON K7K 1Z6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1561-2187","authenticated-orcid":false,"given":"Stefano","family":"Tamburin","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8017-4013","authenticated-orcid":false,"given":"Rita","family":"Di Censo","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy"},{"name":"Neurorehabilitation Unit, Department of Neurosciences, University Hospital of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Aldegheri","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3717-7697","authenticated-orcid":false,"given":"Elisa","family":"Mantovani","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7220-4016","authenticated-orcid":false,"given":"Stefania","family":"Spina","sequence":"additional","affiliation":[{"name":"Spasticity and Movement Disorders \u2018ReSTaRt\u2019 Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1357-1374","authenticated-orcid":false,"given":"Marco","family":"Battaglia","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont \u201cA. Avogadro\u201d, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Baricich","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1452-8485","authenticated-orcid":false,"given":"Andrea","family":"Santamato","sequence":"additional","affiliation":[{"name":"Spasticity and Movement Disorders \u2018ReSTaRt\u2019 Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7630-1887","authenticated-orcid":false,"given":"Nicola","family":"Smania","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy"},{"name":"Neurorehabilitation Unit, Department of Neurosciences, University Hospital of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-8276","authenticated-orcid":false,"given":"Alessandro","family":"Picelli","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy"},{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, ON K7K 1Z6, Canada"},{"name":"Neurorehabilitation Unit, Department of Neurosciences, University Hospital of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.rehab.2018.04.004","article-title":"Onset, time course and prediction of spasticity after stroke or traumatic brain injury","volume":"62","author":"Sunnerhagen","year":"2019","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_2","first-page":"728","article-title":"Spasticity following brain and spinal cord injury: Assessment and treatment","volume":"6","author":"Tamburin","year":"2022","journal-title":"Curr. Opin. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.rehab.2018.10.004","article-title":"The neurophysiology of deforming spastic paresis: A revised taxonomy","volume":"62","author":"Baude","year":"2019","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.pcl.2023.01.005","article-title":"Spasticity Interventions: Decision-Making and Management","volume":"70","author":"Brandenburg","year":"2023","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.rehab.2019.06.001","article-title":"French clinical guidelines for peripheral motor nerve blocks in a PRM setting","volume":"4","author":"Yelnik","year":"2019","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1016\/j.apmr.2023.01.011","article-title":"Recommendations for Ultrasound Guidance for Diagnostic Nerve Blocks for Spasticity. What Are the Benefits?","volume":"9","author":"Winston","year":"2023","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/S0003-9993(03)00405-2","article-title":"Selective blocks of the motor nerve branches to the soleus and tibialis posterior muscles in the management of the spastic equinovarus foot","volume":"85","author":"Deltombe","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/joa.12538","article-title":"Successive motor nerve blocks to identify the muscles causing a spasticity pattern: Example of the arm flexion pattern","volume":"230","author":"Genet","year":"2017","journal-title":"J. Anat."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.rehab.2018.07.008","article-title":"Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity?","volume":"62","author":"Deltombe","year":"2019","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"461","DOI":"10.2340\/16501977-2226","article-title":"Assessment and treatment of spastic equinovarus foot after stroke: Guidance from the Mont-Godinne interdisciplinary group","volume":"49","author":"Deltombe","year":"2017","journal-title":"J. Rehabil. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3132","DOI":"10.1161\/STROKEAHA.111.639831","article-title":"Poststroke spasticity management","volume":"11","author":"Francisco","year":"2012","journal-title":"Stroke"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Filippetti, M., Tamburin, S., Di Censo, R., Adamo, M., Manera, E., Ingr\u00e0, J., Mantovani, E., Facciorusso, S., Battaglia, M., and Baricich, A. (2024). Role of Diagnostic Nerve Blocks in the Goal-Oriented Treatment of Spasticity with Botulinum Toxin Type A: A Case-Control Study. Toxins, 16.","DOI":"10.3390\/toxins16060258"},{"key":"ref_13","first-page":"1386","article-title":"Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper","volume":"11","author":"Comi","year":"2016","journal-title":"Mult. Scler."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1007\/s00415-016-8304-z","article-title":"Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: Review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force","volume":"1","author":"Dressler","year":"2017","journal-title":"J. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1133390","DOI":"10.3389\/fneur.2023.1133390","article-title":"Clinical efficacy of botulinum toxin type A in patients with traumatic brain injury, spinal cord injury, or multiple sclerosis: An observational longitudinal study","volume":"14","author":"Baricich","year":"2023","journal-title":"Front. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1212\/WNL.0000000000002560","article-title":"Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology","volume":"19","author":"Simpson","year":"2016","journal-title":"Neurology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"469","DOI":"10.23736\/S1973-9087.17.04664-0","article-title":"Sonographic guide for botulinum toxin injections of the upper limb: EUROMUSCULUS\/USPRM spasticity approach","volume":"54","author":"Kara","year":"2018","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"486","DOI":"10.23736\/S1973-9087.17.04667-6","article-title":"Sonographic guide for botulinum toxin injections of the lower limb: EUROMUSCULUS\/USPRM spasticity approach","volume":"54","author":"Kaymak","year":"2018","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Asimakidou, E., and Sidiropoulos, C. (2023). A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity. Toxins, 15.","DOI":"10.3390\/toxins15040256"},{"key":"ref_20","first-page":"jrm00241","article-title":"European expert consensus on improving patient selection for the management of disabling spasticity with intrathecal baclofen and\/or botulinum toxin type A","volume":"54","author":"Stevenson","year":"2022","journal-title":"J. Rehabil. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"104376","DOI":"10.1016\/j.msard.2022.104376","article-title":"Symptom burden, management and treatment goals of people with MS spasticity: Results from SEEN-MSS, a large-scale, self-reported survey","volume":"68","author":"Newsome","year":"2022","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"113","DOI":"10.3138\/ptc.2016-25","article-title":"Goals Set by Patients Using the ICF Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution","volume":"2","author":"Choi","year":"2017","journal-title":"Physiother. Can."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Suputtitada, A., Chatromyen, S., Chen, C.P.C., and Simpson, D.M. (2024). Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review. Toxins, 16.","DOI":"10.3390\/toxins16020098"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"jrm00134","DOI":"10.2340\/16501977-2753","article-title":"A practical guide to optimizing the benefits of post-stroke spasticity interventions with botulinum toxin A: An international group consensus","volume":"53","author":"Francisco","year":"2021","journal-title":"J. Rehabil. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Scaglione, F. (2016). Conversion Ratio between Botox\u00ae, Dysport\u00ae, and Xeomin\u00ae in Clinical Practice. Toxins, 8.","DOI":"10.3390\/toxins8030065"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.pmrj.2016.06.016","article-title":"OnabotulinumtoxinA Injection for Poststroke Upper-Limb Spasticity: Guidance for Early Injectors from a Delphi Panel Process","volume":"9","author":"Simpson","year":"2017","journal-title":"PM&R"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/MRR.0b013e328353e3d4","article-title":"Classification of posture in poststroke upper limb spasticity: A potential decision tool for botulinum toxin A treatment?","volume":"35","author":"Hefter","year":"2012","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/j.pmrj.2017.02.014","article-title":"OnabotulinumtoxinA for Lower Limb Spasticity: Guidance from a Delphi Panel Approach","volume":"9","author":"Esquenazi","year":"2017","journal-title":"PM&R"},{"key":"ref_29","unstructured":"(2024, July 01). Worldwide Education and Awareness for Movement Disorders EDITION 3.0. Available online: www.mdvu.org."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"jrm00069","DOI":"10.2340\/16501977-2693","article-title":"Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A retrospective observational study","volume":"52","author":"Picelli","year":"2020","journal-title":"J. Rehabil. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1097\/PHM.0000000000000781","article-title":"Patient Registry of Spasticity Care World: Data Analysis Based on Physician Experience","volume":"96","author":"Esquenazi","year":"2017","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"jrm00275","DOI":"10.2340\/jrm.v54.85","article-title":"Is the outcome of diagnostic nerve block related to spastic muscle echo intensity? A retrospective observational study on patients with spastic equinovarus foot","volume":"54","author":"Filippetti","year":"2022","journal-title":"J. Rehabil. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1002\/ajum.12354","article-title":"Anatomical landmarks for ultrasound-guided rectus femoris diagnostic nerve block in post-stroke spasticity","volume":"4","author":"Facciorusso","year":"2023","journal-title":"Australas. J. Ultrasound Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1097\/PHM.0000000000000344","article-title":"Sonographic tracking of the upper limb peripheral nerves: A pictorial essay and video demonstration","volume":"94","author":"Wu","year":"2015","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_35","first-page":"698","article-title":"Sonographic Tracking of the Lower Limb Peripheral Nerves: A Pictorial Essay and Video Demonstration. Am","volume":"95","author":"Hung","year":"2016","journal-title":"J. Phys. Med. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1002\/ca.22893","article-title":"Localization of nerve entry points as targets to block spasticity of the deep posterior compartment muscles of the leg","volume":"30","author":"Hu","year":"2017","journal-title":"Clin. Anat."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/16\/9\/388\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:50:02Z","timestamp":1760111402000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/16\/9\/388"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,6]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["toxins16090388"],"URL":"https:\/\/doi.org\/10.3390\/toxins16090388","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,6]]}}}