title: Systematic review of the effectiveness of pharmacological interventions in the treatment of spasticity of the hemiparetic lower extremity more than six months post stroke.
abstract: BACKGROUND
  The long-term management of lower limb spasticity after stroke is an important aspect of an individual's physical recovery and quality of life.
  
  
  OBJECTIVE
  To examine the effectiveness of pharmacological interventions in reducing spasticity of the lower limb in chronic stroke survivors.
  
  
  METHODS
  PubMed, CINAHL, and EMBASE were searched for studies in which (1) ≥50% of the sample size had sustained a stroke; (2) the research design was a randomized controlled trial (RCT); (3) the mean time since stroke was ≥6 months for both the treatment and control groups, at the time treatment was initiated; (4) the treatment group received a pharmacological intervention aimed at treating lower limb spasticity; and (5) spasticity was assessed pre and post treatment. Methodological quality of each study was assessed using the PEDro tool.
  
  
  RESULTS
  Nine RCTs (PEDro scores, 4-9) met inclusion criteria and included a pooled sample size of 605 individuals with a mean age of 54.8 years (range, 14-86). Four RCTs provided evidence that botulinum toxin type A was effective in reducing spasticity compared to persons receiving placebo or a phenol neurolytic. One study provided evidence that both alcohol and phenol neurolytics were effective in reducing spasticity. Finally, 4 studies provided evidence that oral and intrathecal medications were effective in reducing lower limb spasticity compared to placebo.
  
  
  CONCLUSIONS
  Pharmacological treatment initiated 6 months post stroke reduced lower limb spasticity. Relevant areas of exploration for future research could include the period of effectiveness, long-term complications, and a cost-benefit analysis of such treatments.
authors.affiliation: Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: McIntyre
authors.forename: Taeweon
authors.initials: T
authors.lastname: Lee
authors.forename: Shannon
authors.initials: S
authors.lastname: Janzen
authors.forename: Rachel
authors.initials: R
authors.lastname: Mays
authors.forename: Swati
authors.initials: S
authors.lastname: Mehta
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D020336:Paraparesis, Spastic / Q000188:drug therapy* / Q000209:etiology; D010291:Paresis / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications / Q000188:drug therapy; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A