Multiple Sclerosis: Enhancing Botulinum Toxin Effects in Spasticity Management, a Systematic Review.

The objective of this review is to document the modalities to enhance the neuromuscular effects of botulinum toxin (BoNT) injection in spastic patients with multiple sclerosis (MS). We conducted a literature review focusing on studies involving BoNT administration for MS-related spasticity and the use of adjunctive therapies aimed at reducing dosage and increasing injection intervals. The findings revealed a limited number of studies specific to MS patients, addressing only a few adjunct techniques, including electrical stimulation, vibration therapy, physical exercise, and extracorporeal shock wave therapy. These preliminary findings highlight the need for further research into integrative therapeutic strategies tailored specifically to the MS population.