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

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.

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Botulinum Toxin Type A for Upper Limb Spasticity in Poststroke Patients: A Meta-analysis of Randomized Controlled Trials

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.104682 ◽

2020 ◽

Vol 29 (6) ◽

pp. 104682

Author(s):

Shiyu Jia ◽

Yang Liu ◽

Liuyan Shen ◽

Xue Liang ◽

Xiaomin Xu ◽

...

Keyword(s):

Botulinum Toxin ◽

Randomized Controlled Trials ◽

Upper Limb ◽

Meta Analysis ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Controlled Trials ◽

Randomized Controlled ◽

Limb Spasticity

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Impact of integrated upper limb spasticity management including repeat botulinum toxin type A (BoNT-A) injections on patient-centred goal attainment in real-life practice: results from the prospective, observational Upper Limb International Spasticity cohort study (ULIS-III) in a Russian subpopulation

Zhurnal nevrologii i psikhiatrii im S S Korsakova ◽

10.17116/jnevro202112111139 ◽

2021 ◽

Vol 121 (11) ◽

pp. 39

Author(s):

S.E. Khat’kova ◽

A. Baikova ◽

P. Maisonobe ◽

D.R. Khasanova

Keyword(s):

Cohort Study ◽

Botulinum Toxin ◽

Upper Limb ◽

Goal Attainment ◽

Botulinum Toxin Type A ◽

Real Life ◽

Type A ◽

Botulinum Toxin Type ◽

Limb Spasticity

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A Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging Study to Compare the Efficacy and Safety of Three Doses of Botulinum Toxin Type A (Dysport) With Placebo in Upper Limb Spasticity After Stroke

Stroke ◽

10.1161/01.str.31.10.2402 ◽

2000 ◽

Vol 31 (10) ◽

pp. 2402-2406 ◽

Cited By ~ 190

Author(s):

A. M. O. Bakheit ◽

A. F. Thilmann ◽

A. B. Ward ◽

W. Poewe ◽

J. Wissel ◽

...

Keyword(s):

Botulinum Toxin ◽

Upper Limb ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Efficacy And Safety ◽

Double Blind ◽

Double Blind Placebo ◽

Limb Spasticity ◽

Dose Ranging

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Treatment of Upper Limb Spasticity after Stroke: One-Year Safety and Efficacy of Botulinum Toxin Type A NT201

International Journal of Immunopathology and Pharmacology ◽

10.1177/03946320120250s109 ◽

2012 ◽

Vol 25 (1_suppl) ◽

pp. 57-62 ◽

Cited By ~ 3

Author(s):

P. Fiore ◽

A. Santamato ◽

M. Ranieri ◽

R.G. Bellomo ◽

R. Saggini ◽

...

Keyword(s):

Botulinum Toxin ◽

Upper Limb ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Safety And Efficacy ◽

Limb Spasticity ◽

One Year

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

BioMed Research International ◽

10.1155/2019/8329306 ◽

2019 ◽

Vol 2019 ◽

pp. 1-17 ◽

Cited By ~ 5

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.

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