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

Abstract

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.

Botulinum neurotoxins for post‐stroke spasticity in adults: A systematic review

“…The large number of patients assessed, their provenance from various countries, and realistic stroke case mix all suggest that the findings of this systematic review have good external validity. Earlier, more limited, analyses provided results, which are encompassed by the present review, 31 which also indicates that available data on BoNT/B are insufficient to assess its effect on spasticity and that further controlled trials using BoNT/B are necessary.…”

“…The inconsistent results on elbow may be due to the small sample size of patients evaluated at this joint, or to insufficient doses injected into the larger proximal muscles, considering that the clinical effects of BoNT/ A are dose-dependent. 30 Previous reviews on the efficacy of BoNT considered the upper limb as a whole [31][32][33] and could not identify distal-to-proximal variations in outcome. The doses used for the smaller muscles varied consistently in the studies included in this review and it was not possible to establish a minimal efficacious dose.…”

BoTULS: a multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A

“…Sixteen randomised controlled trials (RCTs) [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] and five systematic reviews [52][53][54][55][56] evaluating the clinical effectiveness of botulinum toxin as a treatment for upper limb spasticity after stroke have been published. Eight trials [44][45][46][47][48][49][50][51] and four systematic reviews [53][54][55][56] were published following the start of this study in 2005.…”

“…Eight trials [44][45][46][47][48][49][50][51] and four systematic reviews [53][54][55][56] were published following the start of this study in 2005. Details of our literature search strategy, methodological appraisal of the papers, overview of the studies, and a summary of the systematic reviews can be found in Appendix 1.…”

Crioterapia e cinesioterapia no membro superior espástico no acidente vascular cerebral

“…Uma das principais complicações evidenciadas no paciente com sequela de AVC é a espasticidade, que acarreta limitações nas atividades na vida diária do indivíduo (2,8,9) e torna-se um importante fator de risco para o desenvolvimento de deformidades estáticas quando não tratada (2,(8)(9)(10).…”