Efficacy and Optimal Dose of Botulinum Toxin A in Post-Stroke Lower Extremity Spasticity: A Systematic Review and Meta-Analysis

Abstract

Post-stroke spasticity impedes patients’ rehabilitation progress. Contradictory evidence has been reported in using Botulinum Neurotoxin type A (BoNT-A) to manage post-stroke lower extremity spasticity (PLES); furthermore, an optimum dose of BoNT-A for PLES has not yet been established. Therefore, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to identify the efficacy and optimal dose of BoNT-A on PLES. "Meta" and "Metafor" packages in R were used to analyze the data. Hedges’ g statistic and random effect model were used to calculate and pool effect sizes. Twelve RCTs met the eligibility criteria. Muscle tone significantly improved in week four, week eight, and maintained to week twelve after BoNT-A injection. Improvements in functional outcomes were found, some inconsistencies among included studies were noticed. Dosage analysis from eight studies using Botox® and three studies using Dysport® indicated that the optimum dose for the commonest pattern of PLES (spastic plantar flexors) is medium-dose (approximately 300U Botox® or 1000 U Dysport®). BoNT-A should be regarded as part of a rehabilitation program for PLES. Furthermore, an optimal rehabilitation program combined with BoNT-A management needs to be established. Further studies should also focus on functional improvement by BoNT-A management in the early stage of stroke.

The Relationship between Pain and Spasticity and Tell-Tale Signs of Pain in Children with Cerebral Palsy

“…Self-reported pain in CCP is the primary determinator for diminished quality of life [ 4 , 5 ], [ 38 , 39 , 40 ]. In part 1 of this study, we were unable to detect an expected BoNT dose-dependent decrease in spasticity [ 41 , 42 , 43 , 44 , 45 ]. At first glance, this is unexpected because we usually assume a relationship between the dosing of BoNT and modulation/reduction of spasticity.…”

The Efficacy of Transvaginal Ultrasound-Guided BoNT-A External Sphincter Injection in Female Patients with Underactive Bladder

“…Doan et al published a systematic review and meta-analysis to evaluate the efficacy and optimal dose of BoNT-A in the post-stroke lower extremity spasticity (PLES). They found that doses of approximately 300 U of BoNT-A could be the preferable dosage for spastic plantar flexors, which is the most common pattern of PLES [ 27 ]. Interestingly, in our study, we observed that after injecting large doses of BoNT-A into a relatively small muscle group, the women’s external sphincter, the patients showed a significant improvement in lower urinary tract symptoms accompanied by a lower incidence of side effects such as incontinence.…”

Effect of Botulinum Toxin Injections in the Treatment of Spasticity of Different Etiologies: An Umbrella Review

“…Two tables were created, one for systematic reviews ( Table 1 ) and one for meta-analyses ( Table 2 ), showing the characteristics of the studies included in this umbrella review. Of the total number of included studies, 12 were systematic reviews [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] and 16 were meta-analyses [ 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 34 , 35 , 36 , 37 , 38 ]. The studies included in this umbrella review were published between 2001 and 2023.…”

“…The duration of intervention ranged from 0 to 48 months. Almost all the included studies used the MAS [ 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 42 ], five used the Tardieu Scale [ 11 , 18 , 24 , 31 , 32 ], and five used the Modified Tardieu Scale [ 13 , 19 , 25 , 27 , 33 ].…”