Background and Aim: Botulinum toxin type A is considered to be an effective antispasmodic in recent years. We assess the effectiveness of botulinum toxin type A for the treatment of poststroke spasticity in the upper extremity using a meta-analysis. Methods: We searched several databases including PubMed, Web of Science, Embase, and Cochrane database for relevant studies, up until October 2017. All randomized controlled trials of botulinum toxin type A treat poststroke upper limb spasticity published were included. The primary outcome measure was modified ashworth score at the elbow, finger and wrist, pain score, and barthel index. Results: Ten randomized controlled trials were identified and reported sufficient data for inclusion in the pooled analysis (n = 950). The results of modified ashworth score at different joints, pain score, barthel index showed no difference was found in the effectiveness of botulinum toxin type A compared with placebo in the treatment of the upper limb spasticity after stroke. But modified ashworth score at the elbow was improver in Dysport subgroups (standardized mean difference [SMD] = −.39, 95%CI = −.67 to −.10, P = .008) compared with Botox subgroups (SMD = .08, 95%CI = −.68 to .83, P = .84). Conclusions: The meta-analysis of these studies showed that the overall effectiveness of botulinum toxin type A does not seem to differ from placebo for poststroke Patients. But the meta-analysis yielded a favorable effect of Dysport compared with placebo based on 4 trials.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Stroke and Cerebrovascular Diseases
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture.Neurology. 1980; 30: 1303-1313
- Spasticity after stroke: its occurrence and association with motor impairments and activity limitations.Stroke. 2004; 35: 134
- Location and severity of spasticity in the first 1-2weeks and at 3 and 18 months after stroke.Eur J Neurol. 2010; 17: 720-725
- Impairment of voluntary movement by spasticity.Ann Neurol. 1979; 5: 594-595
- Objective assessment of spasticity, strength, and function with early exhibition of dantrolene sodium after cerebrovascular accident: a randomized double-blind study.Arch Phys Med Rehabil. 1992; 73: 4-9
- Systematic literature review of abobotulinumtoxinA in clinical trials for adult upper limb spasticity.Am J Phys Med Rehab. 2015; 94: 229
- A randomized, double-blind, placebo-controlled study of the efficacy and safety of botulinum toxin type A in upper limb spasticity in patients with stroke.Eur J Neurol. 2001; 8: 559
- 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. 2000; 31: 2402
- Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke.N Engl J Med. 2002; 347: 395-400
- Dose-dependent response to intramuscular botulinum toxin type A for upper-limb spasticity in patients after a stroke 1 ☆.Arch Phys Med Rehabil. 2004; 85: 1063-1069
- An early botulinum toxin A treatment in subacute stroke patients may prevent a disabling finger flexor stiffness six months later: a randomized controlled trial.Clini Rehabil. 2012; 68: 237-245
- Botulinum toxin type A in post-stroke upper limb spasticity.Curr Med Res Opin. 2010; 26: 1983-1992
- Botulinum toxin A for treatment of upper limb spasticity following stroke: a multi-centre randomized placebo-controlled study of the effects on quality of life and other person-centred outcomes.J Rehabil Med. 2009; 41: 536
- 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.Health Technol Assess. 2010; 14: 1
- Botulinum toxin for the upper limb after stroke (BoTULS) trial effect on impairment, activity limitation, and pain.Stroke. 2011; 42: 1371
- Botulinum toxin type A in the treatment of upper extremity spasticity: a randomized, double-blind, placebo-controlled trial.Neurology. 1996; 46: 1306-1310
- Treatment with botulinum toxin improves upper-extremity function post stroke: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2013; 94: 977-989
- Evidence-based systematic review on the efficacy and safety of botulinum toxin-A therapy in post-stroke spasticity.J Neural Transm. 2008; 115: 617-623
- Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: a meta-analysis.Arq Neuropsiquiatr. 2005; 63: 30
- Dose response with onabotulinumtoxinA for post-stroke spasticity: a pooled data analysis.Mov Disord. 2011; 26: 209
- Efficacy and safety of botulinum toxin type A for limb spasticity after stroke: a meta-analysis of randomized controlled trials.BioMed Res Int. 2019;
Published online: April 15, 2020
Accepted: January 16, 2020
Received in revised form: December 21, 2019
Received: July 17, 2019
Shi Yu Jia and Yang Liu contributed equally to this work.
Funding: This study was supported by Chongqing Health and Family Planning Commission (no. 2017MSXM023 and no. 2017ZBXM046).
© 2020 Published by Elsevier Inc.