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Meta-Analysis
. 2019 Apr 7:2019:8329306.
doi: 10.1155/2019/8329306. eCollection 2019.

Efficacy and Safety of Botulinum Toxin Type A for Limb Spasticity after Stroke: A Meta-Analysis of Randomized Controlled Trials

Li-Chun Sun  1 , Rong Chen  2 , Chuan Fu  3 , Ying Chen  1 , Qianli Wu  1 , RuiPeng Chen  2 , XueJuan Lin  2 , Sha Luo  1
Affiliations
Meta-Analysis

Efficacy and Safety of Botulinum Toxin Type A for Limb Spasticity after Stroke: A Meta-Analysis of Randomized Controlled Trials

Li-Chun Sun et al. Biomed Res Int. .

Abstract

Background: Inconsistent data have been reported for the effectiveness of intramuscular botulinum toxin type A (BTXA) in patients with limb spasticity after stroke. This meta-analysis of available randomized controlled trials (RCTs) aimed to determine the efficacy and safety of BTXA in adult patients with upper and lower limb spasticity after stroke.

Methods: An electronic search was performed to select eligible RCTs in PubMed, Embase, and the Cochrane library through December 2018. Summary standard mean differences (SMDs) and relative risk (RR) values with corresponding 95% confidence intervals (CIs) were employed to assess effectiveness and safety outcomes, respectively.

Results: Twenty-seven RCTs involving a total of 2,793 patients met the inclusion criteria, including 16 and 9 trials assessing upper and lower limb spasticity cases, respectively. For upper limb spasticity, BTXA therapy significantly improved the levels of muscle tone (SMD=-0.76; 95% CI -0.97 to -0.55; P<0.001), physician global assessment (SMD=0.51; 95% CI 0.35-0.67; P<0.001), and disability assessment scale (SMD=-0.30; 95% CI -0.40 to -0.20; P<0.001), with no significant effects on active upper limb function (SMD=0.49; 95% CI -0.08 to 1.07; P=0.093) and adverse events (RR=1.18; 95% CI 0.72-1.93; P=0.509). For lower limb spasticity, BTXA therapy was associated with higher Fugl-Meyer score (SMD=5.09; 95%CI 2.16-8.01; P=0.001), but had no significant effects on muscle tone (SMD=-0.12; 95% CI -0.83 to 0.59; P=0.736), gait speed (SMD=0.06; 95% CI -0.02 to 0.15; P=0.116), and adverse events (RR=1.01; 95% CI 0.71-1.45; P=0.949).

Conclusions: BTXA improves muscle tone, physician global assessment, and disability assessment scale in upper limb spasticity and increases the Fugl-Meyer score in lower limb spasticity.

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Figures

Figure 1
Figure 1
The literature search and study selection process.
Figure 2
Figure 2
Effect of BTXA on muscle tone in upper limb spasticity.
Figure 3
Figure 3
Effect of BTXA on active upper limb function in upper limb spasticity.
Figure 4
Figure 4
Effect of BTXA on physician global assessments in upper limb spasticity.
Figure 5
Figure 5
Effect of BTXA on disability assessment scale in upper limb spasticity.
Figure 6
Figure 6
Effect of BTXA on adverse events in upper limb spasticity.
Figure 7
Figure 7
Effect of BTXA on muscle tone in lower limb spasticity.
Figure 8
Figure 8
Effect of BTXA on Fugl-Meyer score in lower limb spasticity.
Figure 9
Figure 9
Effect of BTXA on gait speed in lower limb spasticity.
Figure 10
Figure 10
Effect of BTXA on adverse events in lower limb spasticity.
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References

    1. Go A. S., Mozaffarian D., Roger V. L., et al. Heart disease and stroke statistics-2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6–e245. doi: 10.1161/CIR.0b013e31828124ad. - DOI - PMC - PubMed
    1. World Health Organization. The top ten causes of death. WorldHealthOrganization, 2017, http://www.who.int/mediacentre/factsheets/fs310/en/index3.html.
    1. Kim B. R., Lee J., Sohn M. K., et al. Risk factors and functional impact of medical complications in stroke. Annals of Rehabilitation Medicine. 2017;41(5):753–760. doi: 10.5535/arm.2017.41.5.753. - DOI - PMC - PubMed
    1. Kleindorfer D., Panagos P., Pancioli A., et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke. 2005;36(4):720–723. doi: 10.1161/01.STR.0000158917.59233.b7. - DOI - PubMed
    1. Sommerfeld D. K., Eek E. U., Svensson A., Holmqvist L. W., Von Arbin M. H. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke. 2004;35(1):134–139. doi: 10.1161/01.STR.0000105386.05173.5E. - DOI - PubMed

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