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Review
. 2023 Aug 18;15(8):509.
doi: 10.3390/toxins15080509.

Botulinum Toxin-A High-Dosage Effect on Functional Outcome and Spasticity-Related Pain in Subjects with Stroke

Domenico Intiso  1 , Antonello Marco Centra  1 , Michele Gravina  1 , Angelo Chiaramonte  1 , Michelangelo Bartolo  2 , Filomena Di Rienzo  1
Affiliations
Review

Botulinum Toxin-A High-Dosage Effect on Functional Outcome and Spasticity-Related Pain in Subjects with Stroke

Domenico Intiso et al. Toxins (Basel). .

Abstract

Stroke patients can develop spasticity and spasticity-related pain (SRP). These disorders are frequent and can contribute to functional limitations and disabling conditions. Many reports have suggested that higher doses than initially recommended of BTX-A can be used effectively and safely, especially in the case of severe spasticity; however, whether the treatment produces any benefit on the functional outcome and SRP is unclear. Studies published between January 1989 and December 2022 were retrieved from MEDLINE/PubMed, Embase, and Cochrane Central Register. Only obabotulinumtoxinA (obaBTX-A), onabotulinumtoxinA, (onaBTX-A), and incobotulinumtoxinA (incoBTX-A) were considered. The term "high dosage" indicates ≥600 U. Nine studies met the inclusion criteria. Globally, 460 subjects were treated with BTX-A high dose, and 301 suffered from stroke. Studies had variable method designs, sample sizes, and aims. Only five (55.5%) reported data about the functional outcome after BTX-A injection. Functional measures were also variable, and the improvement was observed predominantly in the disability assessment scale (DAS). SRP pain was quantified by visual analog scale (VAS) and only three studies reported the BTX-A effect. There is no scientific evidence that this therapeutic strategy unequivocally improves the functionality of the limbs. Although no clear-cut evidence emerges, certain patients with spasticity might obtain goal-oriented improvement from high-dose BTX-A. Likewise, data are insufficient to recommend high BTX dosage in SRP.

Keywords: botulinum toxin A; functional outcome; high dose; pain; spasticity; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram depicting the selection of articles for the study.
See this image and copyright information in PMC

References

    1. Kong K.H., Lee J., Chua K.S. Occurrence and Temporal Evolution of Upper Limb Spasticity in Stroke Patients Admitted to a Rehabilitation Unit. Arch. Phys. Med. Rehabil. 2012;93:143–148. doi: 10.1016/j.apmr.2011.06.027. - DOI - PubMed
    1. Lance J.W., Feldman R.G., Young R.R., Koeller C. Spasticity: Disordered Motor Control. Yearbook Medical; Chicago, IL, USA: 1980. pp. 485–494.
    1. Andringa A., van Wegen E., van de Port I., Kwakkel G., Meskers C. Measurement Properties of the NeuroFlexor Device for Quantifying Neural and Non-neural Components of Wrist Hyper-Resistance in Chronic Stroke. Front. Neurol. 2019;10:730. doi: 10.3389/fneur.2019.00730. - DOI - PMC - PubMed
    1. Brashear A., Gordon M.F., Elovic E., Kassicieh V.D., Marciniak C., Do M., Lee C.-H., Jenkins S., Turkel C. Intramuscular Injection of Botulinum Toxin for the Treatment of Wrist and Finger Spasticity after a Stroke. N. Engl. J. Med. 2002;347:395–400. doi: 10.1056/NEJMoa011892. - DOI - PubMed
    1. Pirazzini M., Azarnia Tehran D., Zanetti G., Megighian A., Scorzeto M., Fillo S., Shone C.C., Binz T., Rossetto O., Lista F., et al. Thioredoxin and its reductase are present on synaptic vesicles, and their inhibition prevents the paralysis induced by botulinum neurotoxins. Cell Rep. 2014;8:1870–1878. doi: 10.1016/j.celrep.2014.08.017. - DOI - PubMed

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