Medical management of spasticity using botulinum toxin in France: Etiologies and evolution of practices - 26/09/17
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Résumé |
Objective |
Spasticity is a frequent complication of various central nervous system (CNS) pathologies. Botulinum toxin (BoNT) is one of the treatments of spasticity when it causes a patient discomfort.
This analysis explores the evolution of hospital care for spasticity treated with BoNT in France between 2009 and 2014 and describes the main etiologies.
Material/Patients and methods |
Data were extracted from the national Programme Médical de Systemes d’Information (PMSI) database, Médecine-Chirurgie-Obstétrique (MCO) and Soins de Suite et de Réadaptation (SSR) chained 2009–2014. This analysis describes the evolution of the number of patients diagnosed with spasticity and their management using BoNT in MCO and SSR. Etiologies of spasticity were investigated among 33 groups of pathologies (using ICD-10 Codes) described in the literature as etiology of spasticity.
Results |
Over the period, the number of patients coded as having spastic paresis increased by 35%. The main causes of spasticity were stroke (45%), spinal cord damage (SCD: 8%), multiple sclerosis (MS: 8%), traumatic brain injury (TBI: 4%) and CNS tumours (4%). The etiology of spasticity could not be identified in 17% patients, and 2 different etiologies could result in spasticity for 5% patients. Between 2009 and 2014, the number of BoNT injections for spastic paresis increased by 90% (from 19,033 to 36,167). At the same time, the number of annual injections per patient remained relatively stable (+3%). The increase in injections was more pronounced in MCO (+128%) than SSR (+52%). In 2014, 60% of injections were performed in MCO medical units. Among patients with an identified etiology, over the period 2009–2014, 18.5% were treated at least once with BoNT. The proportion of patients treated was higher for patients with TBI (29%) and MS (22%) than for stroke (17%) or SCD (14%).
Discussion/Conclusion |
Management of spasticity using BoNT increased in France between 2009 and 2014. This was mainly due to the increased number of spastic patients diagnosed and subsequently treated. The future reimbursement measures for SSR medical units are likely to lead to a continued increase in the number of patients treated, and an increase of those treated within SSR units.
Le texte complet de cet article est disponible en PDF.Keywords : PMSI, Spasticity, BoNT
Plan
Vol 60 - N° S
P. e23 - septembre 2017 Retour au numéro
Article précédent
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