Effectiveness of Botulinum Toxin Treatment for Upper Limb Spasticity Poststroke Over Different ICF Domains: A Systematic Review and Meta-Analysis

Andringa, Aukje; Port, Ingrid van de; Wegen, Erwin E. H. van; Ket, Hans; Meskers, Carel G.M.; Kwakkel, Gert

doi:10.1016/j.apmr.2019.01.016

Cited by 75 publications

(74 citation statements)

References 71 publications

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“…Hence, our patients had no clinically relevant contracture. On this basis, our findings are in line with the current literature, which reported improvements in passive joint motion and muscle tone after BoNT-A administration in patients with spastic muscle overactivity due to stroke (1,17). Nonetheless, our personal experience suggested that it is not easy to obtain a similar outcome after DNB and BoNT-A injection.…”

Section: Discussionsupporting

confidence: 91%

Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A retrospective observational study

Picelli¹,

Battistuzzi²,

Filippetti³

et al. 2020

J Rehabil Med

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This study reviewed data from 50 chronic stroke patients with spastic equinovarus foot in order to compare the outcome of tibial nerve (main trunk and motor branches) diagnostic block (which temporarily relieves focal muscle overactivity, allowing assessment of the contribution of different muscles) with that of subsequent botulinum toxin injected into the same muscles as were targeted by the nerve block. Outcome measures were passive motility of the affected ankle and overactivity of the calf muscles. All patients were evaluated before and after the nerve block, and 4 weeks after the botulinum toxin injection. Significant improvements were found both after the nerve block and after botulinum toxin injection in comparison with the baseline condition; however, the improvements observed after nerve block were significantly greater. These results confirm that diagnostic nerve block is a useful screening tool for use before botulinum toxin treat ment, although less improvement occurred after botulinum toxin injection compared with after nerve block. Objective: To evaluate the role of diagnostic nerve block in predicting the outcome of subsequent botulinum toxin type A treatment for spastic equinovarus foot due to chronic stroke. Design: Retrospective observational study. Patients: Fifty chronic stroke patients with spastic equinovarus foot. Methods: Each patient was given diagnostic tibial nerve block (lidocaine 2% perineural injection) assessment followed by botulinum toxin type A inoculation into the same muscles as had been targeted by the nerve block. All patients were evaluated before diagnostic nerve block, after the nerve block, and 4 weeks after botulinum toxin injection. Outcomes were ankle dorsiflexion passive range of motion of the affected side, and calf muscle spasticity, measured with the modified Ashworth scale and the Tardieu Scale. Results: Significant improvements were measured after diagnostic nerve block and botulinum toxin injection compared with the baseline condition. Diagnostic nerve block led to significantly greater improvements in all outcomes than botulinum toxin injection. Conclusion: This study confirmed diagnostic nerve block as a valuable screening tool in deciding whether to treat spastic equinovarus with botulinum toxin. However, the results support the evidence that diagnostic nerve block results in a greater reduction in muscle overactivity than does botulinum toxin type A in patients with spastic equinovarus due to stroke.

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Section: Discussionsupporting

confidence: 91%

Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A retrospective observational study

Picelli¹,

Battistuzzi²,

Filippetti³

et al. 2020

J Rehabil Med

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“…Over past 30 years, accumulated evidence has established the effectiveness of BoNT therapy [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. In a recent meta-analysis study of 40 clinical trials [ 34 ], Andringa et al found that there was robust evidence of BoNT on reducing spasticity, as measured with the (Modified) Ashworth Score, and improving self-care ability for the impaired side. BoNT significantly reduced ‘involuntary movements’, However, no evidence was found for functional improvement in ‘arm and hand use’ after BoNT therapy.…”

Section: Introductionmentioning

confidence: 99%

“…For example, BoNT injections to spastic quadriceps are able to reduce spasticity, but the resultant weakness may make weight bearing on the impaired side difficult. This BoNT-related muscle weakness is not well studied, but may contribute to the observation that BoNT therapy does not lead to functional improvement [ 34 ]. However, there are unusual cases when the outcome of BoNT injections surpasses this expectation and results in increase in functional abilities in chronic stroke survivors [ 13 , 39 , 40 ].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Botulinum Toxin Injections on Spasticity and Motor Performance in Chronic Stroke with Spastic Hemiplegia

Chen

Zhang

Liu

et al. 2020

Toxins

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Spastic muscles are weak muscles. It is known that muscle weakness is linked to poor motor performance. Botulinum neurotoxin (BoNT) injections are considered as the first-line treatment for focal spasticity. The purpose of this study was to quantitatively investigate the effects of BoNT injections on force control of spastic biceps brachii muscles in stroke survivors. Ten stroke survivors with spastic hemiplegia (51.7 ± 11.5 yrs; 5 men) who received 100 units of incobotulinumtoxinA or onabotulinumtoxinA to the biceps brachii muscles participated in this study. Spasticity assessment (Modified Ashworth Scale (MAS) and reflex torque) and muscle strength of elbow flexors, as well as motor performance assessment (force variability of submaximal elbow flexion) were performed within one week before (pre-injection) and 3~4 weeks (3-wk) after BoNT injections. As expected, BoNT injections reduced the MAS score and reflex torque, and elbow flexor strength on the spastic paretic side. However, motor performance remained within similar level before and after injections. There was no change in muscle strength or motor performance on the contralateral arm after BoNT injections. The results of this study provide evidence that BoNT injections can reduce spasticity and muscle strength, while motor performance of the weakened spastic muscle remains unchanged.

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“…There is consistent evidence that focal spasticity and associated disabilities after stroke may be reduced by this treatment [ 6 – 12 ] but also that issues remain. Recently, a systematic review by Andringa et al [ 9 ] concluded that while treatment with BTX in the upper limb improves passive movement of spastic wrist and fingers as well as self-care, there is also a demonstrated lack of effects on arm-hand activity performance. A corresponding review of the literature on treatment of lower limbs by Gupta et al [ 12 ] found that the evidence on effects on mobility was not robust and pointed out the need for new controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and potential effects of using the electro-dress Mollii on spasticity and functioning in chronic stroke

Palmcrantz

Pennati

Bergling

et al. 2020

J NeuroEngineering Rehabil

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Background Spasticity after lesions of central motor pathways may be disabling and there is a need for new, cost-effective treatment methods. One novel approach is offered by the electro-dress Mollii®, primarily designed to enhance reciprocal inhibition of spastic muscles by multifocal, transcutaneous antagonist stimulation. Methods The Mollii® suit was set individually for 20 participants living with spasticity and hemiplegia after stroke and used in the home setting for 6 weeks. Usability and perceived effects were monitored by weekly telephone interviews. Outcome was assessed by use of the NeuroFlexor™ method for quantification of the neural component (NC) of resistance to passive stretch (spasticity), and the modified Ashworth scale (MAS) for total resistance, Fugl-Meyer Assessment of motor recovery for sensorimotor function in upper (FM-UE) and lower extremities (FM-LE), activity performance with the Action Research Arm Test (ARAT), Berg balance scale, 10 m and 6 min walk tests, and perceived functioning with the Stroke Impact Scale. Results Compliance was high (mean 19.25 of 21 sessions). Perceived positive effects were reported by 60% and most commonly related to decreased muscle tone (n = 9), improved gait pattern function (n = 7) and voluntary movement in the upper extremity (n = 6). On a group level, the NC decreased significantly in the wrist flexors of the affected hand (p = 0.023) and significant improvements according to FM-UE (p = 0.000) and FM-LE (p = 0.003) were seen after the intervention. No significant difference was detected with MAS or assessed activity performance, except for the ARAT (p = 0.000). FM-UE score change correlated significantly and fairly with the perceived effect in the upper extremity (r 0.498 p = 0.025) and in the corresponding analysis for the FM-LE and perceived effect in the lower extremity (r = 0.469 p = 0.037). Conclusion This study indicates that the Mollii® method is feasible when used in the home setting to decrease spasticity and improve sensorimotor function. The results may guide a larger controlled study combined with rehabilitation interventions to enhance effects on activity and participation domains. Trial registration NCT04076878. Registered 2 September 2019 - Retrospectively registered

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Effectiveness of Botulinum Toxin Treatment for Upper Limb Spasticity Poststroke Over Different ICF Domains: A Systematic Review and Meta-Analysis

Cited by 75 publications

References 71 publications

Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A retrospective observational study

Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A retrospective observational study

The Effects of Botulinum Toxin Injections on Spasticity and Motor Performance in Chronic Stroke with Spastic Hemiplegia

Feasibility and potential effects of using the electro-dress Mollii on spasticity and functioning in chronic stroke

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