title: Botulinum toxin as early intervention for spasticity after stroke or non-progressive brain lesion: A meta-analysis.
abstract: Spasticity is a functionally limiting disorder that commonly occurs following stroke or severe brain injury, and may lead to disability and pain. In tandem with neurorehabilitation, botulinum toxin type A (BoNT-A) is the recommended first-line treatment for spasticity and, to date, the majority of trials have reported BoNT-A use in patients >6months after ictus. The present meta-analysis aimed to evaluate the effects of early BoNT-A injection for post-stroke spasticity on improvements in hypertonicity, disability, function and associated pain. A literature search yielded six studies reporting the effects of BoNT-A treatment within 3months post-stroke; three in the upper limb and three in the lower limb. All six studies permitted concomitant rehabilitation. Reduction in hypertonicity was compared in all six studies and revealed a significant treatment effect (P=0.0002) on the most affected joints between weeks 4 and 12 following injection. However, no significant effects of treatment were observed for improvement in disability at week 4 or improvement in function at weeks 4 and 20-24. A trend towards reduction in spasticity-related pain at week 4 following BoNT-A treatment (P=0.13) was also observed. These results demonstrate the beneficial effects of BoNT-A treatment on improving hypertonicity within 3months post-stroke and emphasise the importance of concomitant neurorehabilitation therapy.
authors.affiliation: Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila 1008, Philippines; International Institute of Neuroscience, Saint Luke's Medical Center, Quezon City 1112, Philippines; Center for Neurodiagnostic and Therapeutic Services, Metropolitan Medical Center, Manila 1000, Philippines. Electronic address: rlrosalesmd88@gmail.com.
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Rosales
authors.affiliation: International Institute of Neuroscience, Saint Luke's Medical Center, Quezon City 1112, Philippines. Electronic address: franefendy@gmail.com.
authors.forename: Fran
authors.initials: F
authors.lastname: Efendy
authors.affiliation: Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila 1008, Philippines. Electronic address: rickateleg@yahoo.com.
authors.forename: Ericka Sa
authors.initials: ES
authors.lastname: Teleg
authors.affiliation: Center for Neurodiagnostic and Therapeutic Services, Metropolitan Medical Center, Manila 1000, Philippines. Electronic address: marymildred8888@yahoo.com.
authors.forename: Mary Md
authors.initials: MM
authors.lastname: Delos Santos
authors.affiliation: Faculty of Medicine and Surgery, University of Santo Tomas, Manila 1015, Philippines. Electronic address: kamille_35@yahoo.com.
authors.forename: Mary Ce
authors.initials: MC
authors.lastname: Rosales
authors.affiliation: Center for Neurodiagnostic and Therapeutic Services, Metropolitan Medical Center, Manila 1000, Philippines. Electronic address: marc_ostrea@yahoo.com.
authors.forename: Marc
authors.initials: M
authors.lastname: Ostrea
authors.affiliation: Center for Neurodiagnostic and Therapeutic Services, Metropolitan Medical Center, Manila 1000, Philippines. Electronic address: mmjoya@yahoo.com.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Tanglao
authors.affiliation: International Institute of Neuroscience, Saint Luke's Medical Center, Quezon City 1112, Philippines; Center for Neurodiagnostic and Therapeutic Services, Metropolitan Medical Center, Manila 1000, Philippines. Electronic address: arngmd@gmail.com.
authors.forename: Arlene R
authors.initials: AR
authors.lastname: Ng
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D006801:Humans; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D000066530:Neurological Rehabilitation / Q000379:methods; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000379:methods
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Early stroke; Lower limb; Rehabilitation; Spasticity; Upper limb