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

Autor: Rosales RL; 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., Efendy F; International Institute of Neuroscience, Saint Luke's Medical Center, Quezon City 1112, Philippines. Electronic address: franefendy@gmail.com., Teleg ES; Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila 1008, Philippines. Electronic address: rickateleg@yahoo.com., Delos Santos MM; Center for Neurodiagnostic and Therapeutic Services, Metropolitan Medical Center, Manila 1000, Philippines. Electronic address: marymildred8888@yahoo.com., Rosales MC; Faculty of Medicine and Surgery, University of Santo Tomas, Manila 1015, Philippines. Electronic address: kamille_35@yahoo.com., Ostrea M; Center for Neurodiagnostic and Therapeutic Services, Metropolitan Medical Center, Manila 1000, Philippines. Electronic address: marc_ostrea@yahoo.com., Tanglao MJ; Center for Neurodiagnostic and Therapeutic Services, Metropolitan Medical Center, Manila 1000, Philippines. Electronic address: mmjoya@yahoo.com., Ng AR; 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.
Jazyk: angličtina
Zdroj: Journal of the neurological sciences [J Neurol Sci] 2016 Dec 15; Vol. 371, pp. 6-14. Date of Electronic Publication: 2016 Oct 11.
DOI: 10.1016/j.jns.2016.10.005
Abstrakt: 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.
(Copyright © 2016 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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