title: Employment of higher doses of botulinum toxin type A to reduce spasticity after stroke.
abstract: Spasticity is a common disabling symptom for several neurological conditions. Botulinum toxin type A injection represents the gold standard treatment for focal spasticity with efficacy, reversibility, and low prevalence of complications. Current guidelines suggest a dose up to 600 units (U) of onabotulinumtoxinA/incobotulinumtoxinA or up to 1,500 U of abobotulinumtoxinA to treat post-stroke spasticity to avoid important adverse effects. However, recently, higher doses of botulinum toxin type A were employed, especially in case of upper and lower limb severe spasticity. With searches of US National Library of Medicine databases, we identified all studies published from December 1989 to July 2014 concerning the use of higher doses of this neurotoxin for spasticity treatment with at least a dose of 600 U of onabotulinumtoxinA and incobotulinumtoxinA or 1,800 U of abobotulinumtoxinA. The cumulative body of evidence coming from the eight studies selected suggested that higher doses of botulinum toxin type A appeared to be efficacious in reducing spasticity of the upper and lower limbs after stroke, with adverse effects generally mild. However, further investigations are needed to determine the safety and reproducibility in larger case series or randomized clinical trials of higher doses of botulinum toxin type A also after repeated injections.
authors: Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy. Electronic address: andrea.santamato@unifg.it.
authors: Andrea
authors: A
authors: Santamato
authors: Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy.
authors: Maria Francesca
authors: MF
authors: Micello
authors: Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy.
authors: Maurizio
authors: M
authors: Ranieri
authors: Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy.
authors: Giovanni
authors: G
authors: Valeno
authors: Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy.
authors: Antonio
authors: A
authors: Albano
authors: Physical Medicine and Rehabilitation, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.
authors: Alessio
authors: A
authors: Baricich
authors: Physical Medicine and Rehabilitation, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.
authors: Carlo
authors: C
authors: Cisari
authors: Department of Neuro-Rehabilitation IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.
authors: Domenico
authors: D
authors: Intiso
authors: Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy; Geriatric Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padova, Italy.
authors: Alberto
authors: A
authors: Pilotto
authors: Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
authors: Giancarlo
authors: G
authors: Logroscino
authors: Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy; Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy. Electronic address: geriat.dot@geriatria.uniba.it.
authors: Francesco
authors: F
authors: Panza
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009128:Muscle Spasticity / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA; C545476:incobotulinumtoxinA
keywords: Lower limb spasticity; Neurotoxins; Nontraumatic acquired brain injury; Upper limb spasticity; Upper motor neuron syndrome