Botulinum Therapy for Pain Caused by Spasticity in Advanced Stages of Brain Tumor in Adolescents: A Case Report.

Background: Spasticity is an upper motor neuron syndrome that exacerbates motor paralysis and is rarely associated with pain. This report elucidates the management of drug-resistant pain attributed to an adolescent brain tumor using botulinum therapy. Case presentation: A 15-year-old female patient experienced dizziness, developed muscle weakness in her upper extremities, and was diagnosed with diffuse glioblastoma of the pons. The tumor responded partially to radiation therapy. Three years later, at the time of recurrence, she had high muscle tone and pain in her extremities. On stimulation, her upper and lower extremities would bend and extend, respectively, causing excruciating pain. Despite experiencing pain-induced insomnia and restlessness, she was reluctant to use drugs, citing concerns about respiratory depression. She received botulinum therapy for her extremities 3 times (200, 300, and 500 U), with pain improvement after repeated treatments (Numerical rating scale from 7.5 to 1 and Short-form McGill Pain Questionnaire-2 score from 78 to 16). The effect lasted for more than three months after the final injection. Conclusion: Thus, botulinum therapy can potentially alleviate spasticity-associated pain in advanced stages of brain tumors in adolescents.