Adult upper limb spasticity

Abstract

The therapeutic role of botulinum neurotoxin (BoNT) in spasticity is controversial. We examined the efficacy and tolerability of BoNT in the management of upper limb post-stroke spasticity in adults. We identified 11 eligible double-blind randomized placebo-controlled trials of variable methodological quality. Primary outcomes were mean changes in Ashworth scores (Ashworth scores) in each limb joint, and the number of participants with least a one-point score reduction. Ten studies compared BoNT-A with placebo. The overall effect on upper limb spasticity was significantly in favor of BoNT-A. Improvement on standardized weighted differences occurred for elbow, wrist and finger flexor spasticity, 3–6 weeks and 9–12 weeks after treatment. No improvement in weighted mean difference was observed in the trial of BoNT-B. Meta-analysis of the number of patients with reduction in Ashworth scores favored BoNT-A compared to placebo; similar data were not available for BoNT-B. BoNT was generally well tolerated. The results of this study indicate that BoNT-A is safe and effective in reducing muscle hypertonia due to spasticity in upper limb joints. Insufficient data were available to assess the efficacy and tolerability of BoNT- B in spasticity.