For treatment of multiple sclerosis (MS) spasticity, Interdisciplinary Working Group of Movement Disorder recommended use of botulinum toxin A (BTA) injection. Literature reported some experiences about use of radial shockwave therapy (RSWT). Aim was to compare therapeutic efficacy of these therapies in patients affected by MS.

We enrolled 32 patients. Inclusion criteria: Modified Ashworth Scale (MAS) from 1 to 2; Expanded Disability Status Scale (EDSS) from 5 to 7.5; no treatment for spasticity in the last 6 months or ongoing pharmacologic therapy; no cognitive deficiency. Patients were randomly divided in 2 groups: A (treated by ultrasound-guided TBA injections in calf muscles) and B (treated by 4 sessions of RSWT). All patients were evaluated before treatment (T0), 1 month (T1) and 3 months (T2) after the end of the treatments, using MAS, Tardieu Index (TI), and ROM measured by two-camera optoelectronic system and surface electromyography (sEMG) of treated muscles, in passive dorsal flexion and active plantar flexion (Fig. 1).

In both groups at T1 we observed: important reduction of MAS and TI score, improvement of ROM active and passive and decrease of tonic stretch reflex. At T2, there was a decrement of results for both therapies, but more statistically significant for RSWT (Fig. 2, Fig. 3).

Both therapies are effective for treating spasticity in MS. BTA injections have prolonged effects. RSWT lost effect shortly after the end of the treatment, but are repeatable without side effects.