title: Assessing the neurophysiological effects of botulinum toxin treatment for adults with focal limb spasticity: a systematic review.
abstract: To examine effectiveness of botulinum toxin therapy (BoNT), accurate quantification of the neurological component of underlying spasticity is needed.
  
  
  OBJECTIVE
  Systematically identify and summarize literature on neurophysiological methods to test the effectiveness of BoNT, discuss methodological aspects, and recommend best techniques for clinical and research settings.
  
  
  METHODS
  Electronic databases were searched using specific keywords. Reviews and reference lists were hand-checked to find relevant studies. Studies in adults with focal limb spasticity were included.
  
  
  RESULTS
  Over 300 articles were scanned for relevance, and a list of 90 relevant articles was made. After excluding reviews and studies in healthy controls or non-spasticity related BoNT, 22 articles were reviewed. Neurophysiological techniques included electromyography (EMG; n = 11), electrical nerve stimulation (n = 13), transcranial magnetic stimulation (TMS; n = 1), functional magnetic resonance imaging (fMRI; n = 1), reflex threshold (n = 4), Achilles tendon reflex (n = 1), reflex latency (n = 1).
  
  
  CONCLUSIONS
  Maximum M-wave amplitude (M-max) and stretch reflex threshold techniques were successfully used to measure the neurophysiological effects of BoNT and have high test-retest reliability. EMG techniques require effective magnitude normalization techniques and establishing test-retest reliability.
  
  
  CONCLUSIONS
  Serial electrical nerve stimulation can be incorporated into clinical practice to assist in follow-up. We recommend using M-max and stretch reflex threshold techniques to assess the neurophysiological effects.
authors.affiliation: Upper Motorneuron Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada. chetan.phadke@westpark.org
authors.forename: Chetan P
authors.initials: CP
authors.lastname: Phadke
authors.forename: Farooq
authors.initials: F
authors.lastname: Ismail
authors.forename: Chris
authors.initials: C
authors.lastname: Boulias
mesh_terms: D000328:Adult; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D004558:Electric Stimulation; D004576:Electromyography; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology; D009128:Muscle Spasticity / Q000188:drug therapy*; D018482:Muscle, Skeletal / Q000187:drug effects / Q000294:innervation; D009482:Neurophysiology
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins