Botulinum toxin A for the treatment of upper limb spasticity after stroke:a Meta-analysis

Xu Huan; Hao Chizi; Zheng Jun; Liao Weijing

doi:10.3969/j.issn.1672-5921.2017.02.001

Abstract：Objective To systematically review the clinical efficacy of botulinum toxin A for the treatment of upper limb spasticity after stroke. Methods PubMed,EMbase,Cochrane Library,CBM, China National Knowledge Internet (CNKI),and Wanfang Data were retrieved by a computer. The randomized controlled trials and Case-control study of comparing botulinum toxin A combined with rehabilitation training and routine rehabilitation treatment for upper limb spasticity after stroke were collected. The retrieval time was from the foundation of the database to September 1,2016. At least two reviewers conducted literature screening,data extraction,and quality evaluation according to the inclusion and exclusion criteria. The Rev-Man 5. 3 software provided by the Cochrane Collaboration was used to conduct the Meta-analysis. Results A total of 356 articles were retrieved. Finally,11 articles met the inclusion criteria. The modified Jadad score showed that the scores of 9 articles were more than 4,which belonged to high-quality literature. Eleven articles included 614 patients,in which 316 were treated with botulinum toxin A. There were 298 patients in the control group. The results of Meta-analysis indicated that the Fugl-Meyer score (SMD =0. 94,95% CI 0. 75 to 1. 12),modified Ashworth score (SMD = - 1. 59,95% CI - 1. 78 to - 1. 40),and modified Barthel index (SMD = 0. 86,95% CI 0. 65 to 1. 08)in the botulinum toxin treatment group were superior to the control group. There were significant differences (all P < 0. 05). The incidence of adverse events (RR = 1. 06,95% CI 0. 78 to 1. 45)was similar in both groups. There was no significant difference (P > 0. 05). Conclusion The efficacy of treatment of upper limb spasticity after stroke with botulinum toxin A is exact,and the security is high. The appropriate rehabilitation training can effectively improve the limb motor function,muscle tension,and quality of life of patients.