scholarly journals Efficacy and Safety of Botulinum Toxin Type A for Limb Spasticity after Stroke: A Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 2019 ◽  
pp. 1-17 ◽  
Author(s):  
Li-Chun Sun ◽  
Rong Chen ◽  
Chuan Fu ◽  
Ying Chen ◽  
Qianli Wu ◽  
...  
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Muscle Tone ◽  
Meta Analysis ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Physician Global Assessment ◽  
Randomized Controlled ◽  
Limb Spasticity ◽  
Lower Limb Spasticity

Background. Inconsistent data have been reported for the effectiveness of intramuscular botulinum toxin type A (BTXA) in patients with limb spasticity after stroke. This meta-analysis of available randomized controlled trials (RCTs) aimed to determine the efficacy and safety of BTXA in adult patients with upper and lower limb spasticity after stroke. Methods. An electronic search was performed to select eligible RCTs in PubMed, Embase, and the Cochrane library through December 2018. Summary standard mean differences (SMDs) and relative risk (RR) values with corresponding 95% confidence intervals (CIs) were employed to assess effectiveness and safety outcomes, respectively. Results. Twenty-seven RCTs involving a total of 2,793 patients met the inclusion criteria, including 16 and 9 trials assessing upper and lower limb spasticity cases, respectively. For upper limb spasticity, BTXA therapy significantly improved the levels of muscle tone (SMD=-0.76; 95% CI -0.97 to -0.55; P<0.001), physician global assessment (SMD=0.51; 95% CI 0.35-0.67; P<0.001), and disability assessment scale (SMD=-0.30; 95% CI -0.40 to -0.20; P<0.001), with no significant effects on active upper limb function (SMD=0.49; 95% CI -0.08 to 1.07; P=0.093) and adverse events (RR=1.18; 95% CI 0.72-1.93; P=0.509). For lower limb spasticity, BTXA therapy was associated with higher Fugl-Meyer score (SMD=5.09; 95%CI 2.16-8.01; P=0.001), but had no significant effects on muscle tone (SMD=-0.12; 95% CI -0.83 to 0.59; P=0.736), gait speed (SMD=0.06; 95% CI -0.02 to 0.15; P=0.116), and adverse events (RR=1.01; 95% CI 0.71-1.45; P=0.949). Conclusions. BTXA improves muscle tone, physician global assessment, and disability assessment scale in upper limb spasticity and increases the Fugl-Meyer score in lower limb spasticity.

scholarly journals Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: a meta-analysis

2005 ◽  
Vol 63 (1) ◽  
pp. 30-33 ◽  
Author(s):  
Eduardo Cardoso ◽  
Bernardo Rodrigues ◽  
Rita Lucena ◽  
Irismar Reis de Oliveira ◽  
Glícia Pedreira ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Muscle Tone ◽  
Meta Analysis ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Definitive Treatment ◽  
Adequate Treatment ◽  
Limb Spasticity

Muscle over-activity is one of the cardinal features of spasticity and it is a common disability of stroke patients. In this group, spasticity is responsible for several limitations that interfere in their daily activities and quality of life. To treat spasticity, neurologists usually prescribe drugs as baclofen, tizanidine or benzodiazepines or even use definitive treatment as phenol or surgery. Authors suggest the use of botulinum toxin type A (BTX-A) for spasticity in the upper limbs after stroke, but there are few papers with adequate methodology supporting this idea. In this article we summarize the data of previous double-blind, randomised clinical trials to asses, with a meta-analysis, if BTX-A is an adequate treatment for spasticity due to stroke. The results show a statistical superiority of BTX-A ov%r placebo on reducing muscle tone by the Modified Ashworth Scale (WMD= 0.95 [0.74 to 1.17]) in patients with post-stroke upper limb spasticity.

scholarly journals Botulinum Toxin Type A Improves Function According to Goal Attainment in Adults with Poststroke Lower Limb Spasticity in Real Life Practice

2019 ◽  
Vol 82 (1-3) ◽  
pp. 1-8 ◽  
Author(s):  
Lourdes López de Munain ◽  
Josep Valls-Solé ◽  
Irene Garcia Pascual ◽  
Pascal Maisonobe ◽  
Keyword(s):  
Botulinum Toxin ◽  
Lower Limb ◽  
Goal Attainment ◽  
Botulinum Toxin Type A ◽  
Real Life ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Goal Achievement ◽  
Limb Spasticity ◽  
Lower Limb Spasticity

Introduction: Botulinum toxin type A (BoNT-A) is an effective and well-tolerated treatment for adult lower limb spasticity. However, data are inadequate to determine BoNT-A efficacy for active function. This study evaluated functional goal achievement (measured by goal attainment scaling [GAS]) following lower limb BoNT-A injection in clinical practice. Methods: Phase 4, postmarketing, multicenter, prospective, observational study (NCT01444794) in adults with poststroke lower limb spasticity receiving one BoNT-A injection cycle. Assessments were at baseline (pretreatment), 1 month ±7 days (visit 1), and 3–5 months posttreatment (visit 2). Primary outcome measure was GAS; additional assessments included Modified Ashworth Scale, Demeurisse Motricity Index, 10-meter walk test, and Disability Assessment Scale. Results: Of 100 enrolled patients, 94 completed the study. Most common primary treatment goals at baseline were improving mobility (57.5%) and positioning (18.1%). At visit 2, 88.3% achieved their primary goal; 87.0% (n = 47/54) for mobility, and 100.0% (n = 17/17) for positioning. In total, 79.1% of patients achieved their secondary goals. Two factors were predictive of primary goal achievement: time since stroke onset (OR 0.907; 95% CI 0.827–0.995; p = 0.038); and absence of stiff knee spasticity pattern (OR 0.228; 95% CI 0.057–0.911; p = 0.036). All functional scales showed improvements; walking speed (mean [SD]) improved by 0.06 (0.13) and 0.05 (0.20) m/s at visits 1 and 2, respectively. Conclusions: BoNT-A injection for lower limb spasticity led to high goal achievement rates in patient-centered GAS evaluation and functional and symptomatic improvements. BoNT-A may therefore deliver clinically meaningful functional improvements in real-life practice.

Analysis of 1-year department activity when treating lower limb spasticity poststroke with botulinum toxin type A

Toxicon ◽  
2018 ◽  
Vol 156 ◽  
pp. S101
Author(s):  
Mariana Santiago ◽  
Helena Tavares ◽  
Maria José Festas ◽  
Fernando Parada
Keyword(s):  
Botulinum Toxin ◽  
Lower Limb ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Limb Spasticity ◽  
Lower Limb Spasticity
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