From Neurophysiological Mechanisms to Rehabilitation After Botulinum Toxin Type A in Post-Stroke Spasticity.
Bart Eeckhaut, Steven Truijen, Parham Haghshenas et al.
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In 30 seconds
This systematic review and meta-analysis examined the neurophysiological mechanisms of botulinum toxin type A (BoNT-A) in treating post-stroke spasticity (PSS) across 39 studies with 760 patients. The analysis revealed significant changes in passive stretch-evoked activity (Hedges' g = 0.80), CMAP amplitude (g = 0.69), and reciprocal motor control (g = 0.52), supporting a peripheral mechanism of action.
Key findings
- Passive stretch-evoked activity showed the largest pooled effect (Hedges' g = 0.80).
- CMAP amplitude demonstrated a significant effect (g = 0.69).
- Reciprocal motor control had a pooled effect size of g = 0.52.
- Effects on voluntary activation and normalized Hmax/Mmax were smaller and more heterogeneous.
Why it matters
Understanding the neurophysiological mechanisms of BoNT-A can enhance rehabilitation strategies for post-stroke spasticity, allowing for more tailored and effective treatment approaches during recovery.
What to keep in mind
The certainty of evidence was low to very low, indicating a need for higher-quality studies.