title: Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI).
  
  
  METHODS
  British Columbia, Canada.
  
  
  METHODS
  EMBASE, MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched for English language studies published up until March 2014. Studies were assessed for eligibility and quality by two independent reviewers.
  
  
  RESULTS
  No controlled trials were identified. A total of 19 studies were included: 9 involving BoNT and 10 involving phenol/alcohol. Owing to the clinically diverse nature of the studies, meta-analysis was deemed inappropriate. The studies produced level 4 and level 5 evidence that chemodenervation with BoNT or alcohol/phenol can lead to improvement in outcome measurements classified in the body structure and function, as well as activity domains of the International Classification of Functioning, Disability and Health framework. The Modified Ashworth Scale (MAS) was the most commonly used outcome measure. All six studies on BoNT and three of the four studies on phenol/alcohol measuring MAS reported a decrease in at least one point. An improvement in MAS was not always associated with improvement in function. The effect of phenol/alcohol has the potential to last beyond 6 months; study follow-up did not occur beyond this time point.
  
  
  CONCLUSIONS
  Chemodenervation with BoNT or phenol/alcohol may improve spasticity and function in individuals with SCI. However, there is a lack of high-quality evidence and further research is needed to confirm the efficacy of these interventions.
authors.affiliation: International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Lui
authors.affiliation: International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Sarai
authors.affiliation: 1] International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada [2] Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada [3] GF Strong Rehabilitation Center, Vancouver Coastal Health, Vancouver, British Columbia, Canada [4] Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
authors.forename: P B
authors.initials: PB
authors.lastname: Mills
mesh_terms: D000777:Anesthetics / Q000009:adverse effects / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use; D000068456:Clinical Studies as Topic; D000431:Ethanol / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D019800:Phenol / Q000009:adverse effects / Q000627:therapeutic use; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*
chemical_list: D000777:Anesthetics; D019800:Phenol; D000431:Ethanol; D019274:Botulinum Toxins, Type A