title: OnabotulinumtoxinA muscle injection patterns in adult spasticity: a systematic literature review.
abstract: BACKGROUND
  OnabotulinumtoxinA has demonstrated significant benefit in adult focal spasticity. This study reviews the injection patterns (i.e., muscle distribution, dosing) of onabotulinumtoxinA for treatment of adult spasticity, as reported in published studies.
  
  
  METHODS
  A systematic review of clinical trials and observational studies published between 1990 and 2011 reporting data on muscles injected with onabotulinumtoxinA in adult patients treated for any cause of spasticity.
  
  
  RESULTS
  28 randomized, 5 nonrandomized, and 37 single-arm studies evaluating 2,163 adult patients were included. The most frequently injected upper-limb muscles were flexor carpi radialis (64.0% of patients), flexor carpi ulnaris (59.1%), flexor digitorum superficialis (57.2%), flexor digitorum profundus (52.5%), and biceps brachii (38.8%). The most frequently injected lower-limb muscles were the gastrocnemius (66.1% of patients), soleus (54.7%), and tibialis posterior (50.5%). The overall dose range reported was 5-200 U for upper-limb muscles and 10-400 U for lower-limb muscles.
  
  
  CONCLUSIONS
  The reviewed evidence indicates that the muscles most frequently injected with onabotulinumtoxinA in adults with spasticity were the wrist, elbow, and finger flexors and the ankle plantar flexors. OnabotulinumtoxinA was injected over a broad range of doses per muscle among the studies included in this review, but individual practitioners should be mindful of local regulatory approvals and regulations.
authors.affiliation: Epidemiology & Database Analytics, United BioSource Corporation, Lexington, MA, USA. lnalysnyk@aol.com.
authors.forename: Luba
authors.initials: L
authors.lastname: Nalysnyk
authors.forename: Spyridon
authors.initials: S
authors.lastname: Papapetropoulos
authors.forename: Philip
authors.initials: P
authors.lastname: Rotella
authors.forename: Jason C
authors.initials: JC
authors.lastname: Simeone
authors.forename: Katharine E
authors.initials: KE
authors.lastname: Alter
authors.forename: Alberto
authors.initials: A
authors.lastname: Esquenazi
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D007273:Injections, Intramuscular; D009128:Muscle Spasticity / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000008:administration & dosage*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A