Further Assessment to Determine the Additive Effect of Botulinum Toxin Type A on an Upper Extremity Exercise Program to Enhance Function Among Individuals With Chronic Stroke but Extensor Capability

Guidelines for Adult Stroke Rehabilitation and Recovery

“…Thus, there is no evidence to suggest that botulinum toxin injections will improve functional upper limb use, but it may improve limb active or passive limb positioning for activities such as dressing and hygiene. 559,560 Although botulinum toxins are clinically recommended for spasticity reduction, it is not clear that they are a cost-effective means to manage spastic hypertonia compared with physical or occupational therapies alone. 541 However, if a reduction in caregiver burden is taken into account, the use of botulinum toxins with therapy may be cost-effective.…”

Spasticity after stroke: Physiology, assessment and treatment

“…Only Botox (onabotulinumtoxin A) is approved by the United States' Food and Drug Administration (FDA) for the treatment of upper limb spasticity in adults at the elbow (biceps), wrist (flexor carpi ulnaris and radialis) and fingers (flexor digitorum profundus and flexor digitorum sublimis [118] and no study on its efficiency for the lower limbs has been done yet. In conclusion, BoNT-A can be useful for reducing spasticity and have less side-effects than other injectable drugs, such as phenol and alcohol [108,119].…”

Does Spasticity Reduction by Botulinum Toxin Type A Improve Upper Limb Functionality in Adult Post-Stroke Patients? A Systematic Review of Relevant Studies

“…Of these, 17 were excluded due to exclusion criteria: i) one trial in which post stroke spasticity was treated by botulinum toxin type B (rimabotulinumtoxinB) [21]; ii) three trial that evaluated the effect of BTX-A given early post stroke before clinically evident spasticity [22][23][24]; iii) one trial that studied the effect of BTX-A dilution and endplate-targeting in sole spastic biceps [25]; iv) five trials enrolling mixed sample of subjects with spasticity secondary to brain injury, multiple sclerosis other than stroke [9,[26][27][28][29]; v) six studies focusing the effect of BTX-A on the reduction of pain associated to spastic shoulder [30][31][32][33][34][35] and one trial that investigated the effects of BTX-A on associated reactions of spasticity [36]. The remaining 17 RTs were included [11,13,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. Since one study reported secondary analysis of finding previously published, both were considered as single study, leaving 16 RTs in the analysis [13,47].…”

“…Of these, one study investigated BTX-A plus ES compared to solely ES. The remaining three studies concerned BTX-A and physiotherapy strategies: one described the effect of combined BTX-A plus modified constraint induced therapy (mCIT) compared to BTX-A plus conventional physiotherapy [48], one study in which BTX-A plus physical therapy was compared to placebo plus physical therapy [51], and one study without placebo group that compared BTX-A plus standardized physiotherapy to group with solely standardized therapy [49,50]. In six studies, it was commonly noted that all participants received or continued a physical rehabilitation program, but the content of this was not described [38,[40][41][42][43][44].…”