Botulinum Toxin Type A For Upper Limb Spasticity In Post-stroke Patients:A Meta-analysis Of Randomized Controlled Trials

Objective Botulinum toxin type A(BTX-A)is considered to be an effective antispasmodic in recent years.We assessed the effectiveness of BTX-A for the treatment of post-stroke spasticity in the upper extremity using a meta-analysis.Methods We searched several databases including PubMed,Web of Science,Embase and Cochrane database for relevant studies,up until October 2017.All RCTs of BTX-A treat post-stroke upper limb spasticity published were included.The primary outcome measure was modified ashworth score(MAS)at the elbow,MAS at the finger,MAS at the wrist,pain score and barthel index.Results Ten RCTs were identified and reported sufficient data for inclusion in the pooled analysis(n=950).The results of MAS at different joints,pain score,barthel index showed that no difference was found in the effectiveness of BTX-A compared with placebo in the treatment of the upper limb spasticity after stroke.But MAS at the elbow was meliorative inDysport subgroups(SMD =-0.39,95% CI =-0.67 to-0.10,P = 0.008)compared with Botox subgroups(SMD=0.08,95% CI =-0.68 to 0.83,P =0.84).Conclusions The meta-analysis of these studies showed that the overall effectiveness of BTX-A did not seem to differ from placebo for Post-stroke patients.But the meta-analysis yielded a favorable effect of Dysport compared with placebo based on four trials.