Botulinum neurotoxins for post-stroke spasticity in adults: a systematic review.
Identifieur interne : 001E12 ( PubMed/Curation ); précédent : 001E11; suivant : 001E13Botulinum neurotoxins for post-stroke spasticity in adults: a systematic review.
Auteurs : Antonio Emanuele Elia [Italie] ; Graziella Filippini ; Daniela Calandrella ; Alberto AlbaneseSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2009.
English descriptors
- KwdEn :
- MESH :
- chemical , therapeutic use : Anti-Dyskinesia Agents, Botulinum Toxins.
- complications : Stroke.
- drug therapy : Muscle Spasticity.
- etiology : Muscle Spasticity.
- Humans.
Abstract
The aim of this systematic review was to determine whether botulinum neurotoxin (BoNT) reduce spasticity or improve function in adult patients after stroke. Eleven double-blind randomized placebo-controlled trials met inclusion criteria. They encompassed 782 patients, 767 (98%) of whom received BoNT/A, and 15 (2%) BoNT/B. Most studies used the Ashworth scale as primary outcome measure. Differences between treated and control groups were assessed as categorical or continuous comparisons. The overall effect on upper limb spasticity was in favor of BoNT/A. A significantly higher number of patients had a reduction of upper limb spasticity at 4-week and 8-week evaluations in the treatment group compared with placebo. Mean changes in joint spasticity revealed improvement 3 to 6 weeks and 9 to 12 weeks after treatment. There were insufficient data to establish BoNT/A efficacy on lower limb spasticity or the effect of BoNT/B on the upper and lower limbs. Because of inconsistency and heterogeneity of the available data, it was not possible to perform a meta-analysis on disability and patients' reported outcomes. There was an overlapping safety profile between the treatment and the placebo groups. BoNT/A reduces upper limb spasticity in patients post-stroke, but the improvement in functional ability remains to be established. This gap needs to be filled by new studies to assess the effect of BoNT in the context of multidisciplinary patient management.
DOI: 10.1002/mds.22452
PubMed: 19224614
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Celoria 11, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Filippini, Graziella" sort="Filippini, Graziella" uniqKey="Filippini G" first="Graziella" last="Filippini">Graziella Filippini</name></author><author><name sortKey="Calandrella, Daniela" sort="Calandrella, Daniela" uniqKey="Calandrella D" first="Daniela" last="Calandrella">Daniela Calandrella</name></author><author><name sortKey="Albanese, Alberto" sort="Albanese, Alberto" uniqKey="Albanese A" first="Alberto" last="Albanese">Alberto Albanese</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2009">2009</date><idno type="doi">10.1002/mds.22452</idno><idno type="RBID">pubmed:19224614</idno><idno type="pmid">19224614</idno><idno type="wicri:Area/PubMed/Corpus">001E12</idno><idno type="wicri:Area/PubMed/Curation">001E12</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Botulinum neurotoxins for post-stroke spasticity in adults: a systematic review.</title><author><name sortKey="Elia, Antonio Emanuele" sort="Elia, Antonio Emanuele" uniqKey="Elia A" first="Antonio Emanuele" last="Elia">Antonio Emanuele Elia</name><affiliation wicri:level="1"><nlm:affiliation>Fondazione IRCCS Istituto Neurologico Carlo Besta, Via G. 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Eleven double-blind randomized placebo-controlled trials met inclusion criteria. They encompassed 782 patients, 767 (98%) of whom received BoNT/A, and 15 (2%) BoNT/B. Most studies used the Ashworth scale as primary outcome measure. Differences between treated and control groups were assessed as categorical or continuous comparisons. The overall effect on upper limb spasticity was in favor of BoNT/A. A significantly higher number of patients had a reduction of upper limb spasticity at 4-week and 8-week evaluations in the treatment group compared with placebo. Mean changes in joint spasticity revealed improvement 3 to 6 weeks and 9 to 12 weeks after treatment. There were insufficient data to establish BoNT/A efficacy on lower limb spasticity or the effect of BoNT/B on the upper and lower limbs. Because of inconsistency and heterogeneity of the available data, it was not possible to perform a meta-analysis on disability and patients' reported outcomes. There was an overlapping safety profile between the treatment and the placebo groups. BoNT/A reduces upper limb spasticity in patients post-stroke, but the improvement in functional ability remains to be established. This gap needs to be filled by new studies to assess the effect of BoNT in the context of multidisciplinary patient management.</div></front></TEI><pubmed><MedlineCitation Owner="NLM" Status="MEDLINE"><PMID Version="1">19224614</PMID><DateCreated><Year>2009</Year><Month>05</Month><Day>04</Day></DateCreated><DateCompleted><Year>2009</Year><Month>07</Month><Day>29</Day></DateCompleted><DateRevised><Year>2010</Year><Month>11</Month><Day>18</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1531-8257</ISSN><JournalIssue CitedMedium="Internet"><Volume>24</Volume><Issue>6</Issue><PubDate><Year>2009</Year><Month>Apr</Month><Day>30</Day></PubDate></JournalIssue><Title>Movement disorders : official journal of the Movement Disorder Society</Title><ISOAbbreviation>Mov. 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A significantly higher number of patients had a reduction of upper limb spasticity at 4-week and 8-week evaluations in the treatment group compared with placebo. Mean changes in joint spasticity revealed improvement 3 to 6 weeks and 9 to 12 weeks after treatment. There were insufficient data to establish BoNT/A efficacy on lower limb spasticity or the effect of BoNT/B on the upper and lower limbs. Because of inconsistency and heterogeneity of the available data, it was not possible to perform a meta-analysis on disability and patients' reported outcomes. There was an overlapping safety profile between the treatment and the placebo groups. BoNT/A reduces upper limb spasticity in patients post-stroke, but the improvement in functional ability remains to be established. This gap needs to be filled by new studies to assess the effect of BoNT in the context of multidisciplinary patient management.</AbstractText><CopyrightInformation>(c) 2009 Movement Disorder Society.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Elia</LastName><ForeName>Antonio Emanuele</ForeName><Initials>AE</Initials><AffiliationInfo><Affiliation>Fondazione IRCCS Istituto Neurologico Carlo Besta, Via G. 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