A combined therapeutic approach: extracorporeal shock wave therapy and botulinum toxin in multiple sclerosis-related spasticity.

Introduction: Focal extracorporeal shock wave therapy (fESWT) is a non-invasive treatment for spasticity in neurological disorders; evidence in multiple sclerosis (MS) is limited. The aim of this study is to evaluate whether its combination with botulinum toxin injections (BTI) could provide rapid and sustained clinical benefit. Methods: This single-center retrospective study included people with MS-related spasticity treated with fESWT and BTI. Global perceived benefit was collected. Modified Ashworth Scale (mAS), Penn Spasm Frequency Scale (frequency-fPSFS and intensity-iPSFS), Numeric Rating Scale for pain (NRS) were collected at baseline (pre and post-treatment), at day 7 and 28. To assess the treatment efficacy on all muscle groups, linear mixed-effects models were implemented. As exploratory analyses, a general linear model for repeated measures was applied for the subgroup analysis aimed at evaluating the efficacy of the treatment in each muscle group. Results: Fifteen PwMS were enrolled. The treated muscles were: adductors, rectus femoris, hamstrings, triceps surae, and biceps brachii. Fourteen subjects (93.3%) reported an immediate benefit, confirmed 28 days later. Eight subjects (53.3%) reported sustained benefit in spasticity. In all-muscles analysis, significant effect was found for mAS [ Discussion: This study suggests that combined treatment with fESWT+BTI is effective for the treatment of MS-related spasticity, with fESWT offering non-invasive and immediate relief while botulinum toxin becomes fully effective.