The Effect of Botulinum Neurotoxin-A (BoNT-A) on Muscle Strength in Adult-Onset Neurological Conditions with Focal Muscle Spasticity: A Systematic Review

Overview

Journal Toxins (Basel)

Publisher MDPI

Specialty Toxicology

Date 2024 Aug 28

PMID 39195757

Authors

Renee Gill

Megan Banky

Zonghan Yang

Pablo Medina Mena

Chi Ching Angie Woo

Adam Bryant

John Olver

Elizabeth Moore

Gavin Williams

Affiliations

Soon will be listed here.

Abstract

Botulinum neurotoxin-A (BoNT-A) injections are effective for focal spasticity. However, the impact on muscle strength is not established. This study aimed to investigate the effect of BoNT-A injections on muscle strength in adult neurological conditions. Studies were included if they were Randomised Controlled Trials (RCTs), non-RCTs, or cohort studies ( ≥ 10) involving participants ≥18 years old receiving BoNT-A injection for spasticity in their upper and/or lower limbs. Eight databases (CINAHL, Cochrane, EMBASE, Google Scholar, Medline, PEDro, Pubmed, Web of Science) were searched in March 2024. The methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42022315241). Quality was assessed using the modified Downs and Black checklist and the PEDro scale. Pre-/post-injection agonist, antagonist, and global strength outcomes at short-, medium-, and long-term time points were extracted for analysis. Following duplicate removal, 8536 studies were identified; 54 met the inclusion criteria (3176 participants) and were rated as fair-quality. Twenty studies were analysed as they reported muscle strength specific to the muscle injected. No change in agonist strength after BoNT-A injection was reported in 74% of the results. Most studies' outcomes were within six weeks post-injection, with few long-term results (i.e., >three months). Overall, the impact of BoNT-A on muscle strength remains inconclusive.

References

Barden H, Baguley I, Nott M, Chapparo C . Measuring spasticity and fine motor control (pinch) change in the hand after botulinum toxin-A injection using dynamic computerized hand dynamometry. Arch Phys Med Rehabil. 2014; 95(12):2402-9. DOI: 10.1016/j.apmr.2014.05.017. View

Haddaway N, Collins A, Coughlin D, Kirk S . The Role of Google Scholar in Evidence Reviews and Its Applicability to Grey Literature Searching. PLoS One. 2015; 10(9):e0138237. PMC: 4574933. DOI: 10.1371/journal.pone.0138237. View

Pingel J, Hultborn H, Naslund-Koch L, Jensen D, Wienecke J, Nielsen J . Muscle disuse caused by botulinum toxin injection leads to increased central gain of the stretch reflex in the rat. J Neurophysiol. 2017; 118(4):1962-1969. PMC: 5626886. DOI: 10.1152/jn.00276.2017. View

Tardieu G, SHENTOUB S, Delarue R . [Research on a technic for measurement of spasticity]. Rev Neurol (Paris). 1954; 91(2):143-4. View

Yaraskavitch M, Leonard T, Herzog W . Botox produces functional weakness in non-injected muscles adjacent to the target muscle. J Biomech. 2008; 41(4):897-902. DOI: 10.1016/j.jbiomech.2007.11.016. View

Moore J, Potter K, Blankshain K, Kaplan S, ODwyer L, Sullivan J . A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation: A CLINICAL PRACTICE GUIDELINE. J Neurol Phys Ther. 2018; 42(3):174-220. PMC: 6023606. DOI: 10.1097/NPT.0000000000000229. View

Intiso D, Simone V, Di Rienzo F, Iarossi A, Pazienza L, Santamato A . High doses of a new botulinum toxin type A (NT-201) in adult patients with severe spasticity following brain injury and cerebral palsy. NeuroRehabilitation. 2014; 34(3):515-22. DOI: 10.3233/NRE-141052. View

Williams G, Morris M, Schache A, McCrory P . Incidence of gait abnormalities after traumatic brain injury. Arch Phys Med Rehabil. 2009; 90(4):587-93. DOI: 10.1016/j.apmr.2008.10.013. View

Tsuchiya M, Morita A, Hara Y . Effect of Dual Therapy with Botulinum Toxin A Injection and Electromyography-controlled Functional Electrical Stimulation on Active Function in the Spastic Paretic Hand. J Nippon Med Sch. 2016; 83(1):15-23. DOI: 10.1272/jnms.83.15. View

10.

Kluding P, Gajewski B . Lower-extremity strength differences predict activity limitations in people with chronic stroke. Phys Ther. 2008; 89(1):73-81. DOI: 10.2522/ptj.20070234. View

11.

OConnor S, Tully M, Ryan B, Bradley J, Baxter G, McDonough S . Failure of a numerical quality assessment scale to identify potential risk of bias in a systematic review: a comparison study. BMC Res Notes. 2015; 8:224. PMC: 4467625. DOI: 10.1186/s13104-015-1181-1. View

12.

Kwakkel G, Lannin N, Borschmann K, English C, Ali M, Churilov L . Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke. 2017; 12(5):451-461. DOI: 10.1177/1747493017711813. View

13.

Thibaut A, Chatelle C, Ziegler E, Bruno M, Laureys S, Gosseries O . Spasticity after stroke: physiology, assessment and treatment. Brain Inj. 2013; 27(10):1093-105. DOI: 10.3109/02699052.2013.804202. View

14.

Chen Y, Liu Y, Zhang C, Magat E, Zhou P, Zhang Y . Comprehensive Assessment of the Time Course of Biomechanical, Electrophysiological and Neuro-Motor Effects after Botulinum Toxin Injections in Elbow Flexors of Chronic Stroke Survivors with Spastic Hemiplegia: A Cross Sectional Observation Study. Toxins (Basel). 2022; 14(2). PMC: 8875179. DOI: 10.3390/toxins14020104. View

15.

Burke D, Wissel J, Donnan G . Pathophysiology of spasticity in stroke. Neurology. 2013; 80(3 Suppl 2):S20-6. DOI: 10.1212/WNL.0b013e31827624a7. View

16.

Akshintala S, Khalil N, Yohay K, Muzikansky A, Allen J, Yaffe A . Reliability of Handheld Dynamometry to Measure Focal Muscle Weakness in Neurofibromatosis Types 1 and 2. Neurology. 2021; 97(7 Suppl 1):S99-S110. PMC: 8593999. DOI: 10.1212/WNL.0000000000012439. View

17.

Bhakta B, Cozens J, Chamberlain M, Bamford J . Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial. J Neurol Neurosurg Psychiatry. 2000; 69(2):217-21. PMC: 1737061. DOI: 10.1136/jnnp.69.2.217. View

18.

Rousseaux M, Kozlowski O, Froger J . Efficacy of botulinum toxin A in upper limb function of hemiplegic patients. J Neurol. 2002; 249(1):76-84. DOI: 10.1007/pl00007851. View

19.

Moore E, Banky M, Olver J, Bryant A, Williams G . The effectiveness of therapy on outcome following (BoNT-A) injection for focal spasticity in adults with neurological conditions: A systematic review. Brain Inj. 2015; 29(6):676-87. DOI: 10.3109/02699052.2015.1004749. View

20.

Meythaler J, Vogtle L, Brunner R . A preliminary assessment of the benefits of the addition of botulinum toxin a to a conventional therapy program on the function of people with longstanding stroke. Arch Phys Med Rehabil. 2009; 90(9):1453-61. DOI: 10.1016/j.apmr.2009.02.026. View