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Botulinum toxin as early intervention for spasticity after stroke or non-progressive brain lesion: A meta-analysis.


Raymond L. Rosales,
Fran Efendy,
Ericka  S. Teleg,
Mary  M. Delos Santos,
Mary  C. Rosales,
Marc Ostrea,
Michelle  J. Tanglao,
Arelene R. Ng

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Department of Neurology and Psychiatry - University of Santo Tomas Hospital

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Publication Information

Publication Type
Journal of the Neurological Sciences
Publication Date
October 2016


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 N6 months 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 3 months 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 3 months post-stroke and emphasize the importance of concomitant neurorehabilitation therapy.

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