Treating spasms associated with cerebrospinal lesions with stereotactic radiosurgery, a form of radiotherapy as precise as a scalpel, which combines efficacy and safety. The first center in the world to propose it as an innovative experimental treatment for the complications of brain-spinal damage is the Irccs Sacro Cuore Don Calabria in Negrar, in the province of Verona. “In 2022, we treated 4 patients with spasticity using stereotactic radiosurgery, obtaining important results with a reduction or resolution of spasticity and no toxicity related to the treatment, as reported in a study published in ‘Radiotherapy and Oncology’ – explains Luca Nicosia, radiation oncologist at the institute – The positive results achieved have led us to start the current trial that plans to enroll 10 adult patients, affected by widespread spasticity that cannot be treated with traditional therapies”.
There are approximately 100 million people in the world who live with the consequences of cerebrospinal pathologies or trauma to the brain and spinal cord following accidents, the IRCCS of Verona recalls. Among these, spasticity and related pain are a common and debilitating long-term complication. It is estimated that it affects 65-78% of patients with chronic spinal cord injuries and 25% of those who have had a serious stroke. Conventional treatments to date involve invasive surgical interventions, such as the use of baclofen pumps that must be inserted into the abdominal cavity to deliver the drug from the inside, or the use of selective dorsal rhizotomy, a neurosurgical technique that consists of interrupting the connection between certain nerves and the spinal cord. Less invasive oral treatments are also possible, but these too have limited efficacy and are often accompanied by unwanted side effects.
The researchers from Negrar have instead defined “a new experimental protocol for the non-invasive, more conservative and low-toxicity treatment of spasticity by means of stereotactic radiosurgery – reports a note – which involves the use of radiotherapy to act on selected spinal nerves blocking the electrical conduction responsible for the spasms”.
“Spasticity is a condition characterized by an excessive and abnormal increase in muscle tone – describes Elena Rossato, director of the Physical Medicine and Rehabilitation Service of the IRCCS of Negrar – In particular, it consists of spasms of one or more skeletal muscles that can cause stiffness during movement with discomfort or pain and motor difficulties in the 4 limbs, in breathing and in nighttime rest. Spasticity therefore has a great negative impact on the quality of life of patients and strongly interferes with their ability to perform daily activities such as transferring from a wheelchair. For this reason, spasticity has several social and rehabilitative consequences, with a high rate of nursing procedures, hospital admissions and costs”.
“What has been started at the IRCCS in Negrar – explains Nicosia – is a protocol that involves the use of stereotactic radiosurgery to treat patients suffering from disabling spasms. The treatments currently available for this condition involve the use of drugs, burdened by side effects and a progressive loss of efficacy, or surgical interventions that, in addition to requiring specific expertise, subject very fragile patients to major operations with potentially debilitating consequences. The baclofen infuser requires, for example, an intervention that could expose patients to complications, it also needs to be recharged periodically and can be subject to infections. In addition to this, patients could become progressively resistant to the treatment. Other therapies such as the injection of intramuscular botulinum toxin or perineural alcohol injections are limited in dose and must be repeated over time, while solutions such as surgical neurolysis, selective neurotomies and rhizotomies are characterized by prolonged surgical sessions, complications and require an expert team”.
“Stereotactic radiosurgery – the specialist emphasizes – is a non-invasive option with high precision, which requires a single treatment session lasting 40 minutes. The treatment is definitive on the treated areas and has the ability to reduce or eliminate spasticity. The treatment can be repeated, but only on other areas”.
“Stereotactic radiosurgery is typically used to intervene on primary and metastatic solid tumors, and for the treatment of non-oncological diseases such as Graves’ ophthalmopathy, cardiac arrhythmias and trigeminal neuralgia”, Nicosia points out. “Ours – he specifies – is the first center in the world to propose this innovative treatment” for spasticity caused by cerebrospinal lesions, “within a multidisciplinary research project that involves, in addition to oncological radiotherapy, physiatry, neurology and anesthesia to prove its efficacy”.
“The primary objective of the study” underway, concludes Rossato, “will be to estimate the reduction in the frequency and intensity of spasms after treatment, monitoring them at 1, 3, 6 and 12 months after stereotactic radiosurgery. Secondary objectives, in addition, will also include those of evaluating acute and late toxicity and the rate of relapse of spasticity, and describing the change in the patient’s quality of life after treatment and the improvement in the caregivers’ workload”.
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