Assessing the neurophysiological effects of botulinum toxin treatment for adults with focal limb spasticity: a systematic review

Phadke, Chetan P.; Ismail, Farooq; Boulias, Chris

doi:10.3109/09638288.2011.591882

Cited by 17 publications

(19 citation statements)

References 59 publications

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“…To reduce the variability inherent in RMS‐EMG and to be able to compare between participants, signals can be normalized to a maximum voluntary contraction, as was done in two of the reviewed studies . However, this normalization technique in persons with co‐contraction and weakness is debatable . EMG can also be normalized to an M‐wave during a supramaximal stimulation although more studies are required to assess the clinical applicability of such a method.…”

Section: Discussionmentioning

confidence: 99%

“…44,45 However, this normalization technique in persons with co-contraction and weakness is debatable. 51 EMG can also be normalized to an M-wave during a supramaximal stimulation 52 although more studies are required to assess the clinical applicability of such a method. As an essential start, better protocol standardization is required to reduce the variability of RMS-EMG parameters.…”

Section: Discussionmentioning

confidence: 99%

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Manually controlled instrumented spasticity assessments: a systematic review of psychometric properties

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Aertbeliën

Molenaers

et al. 2014

Develop Med Child Neuro

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EMGMETHOD Electronic databases were searched to identify studies that assessed spasticity by simultaneously collecting electrophysiological and biomechanical signals during manually controlled passive muscle stretches. Two independent reviewers critically assessed the methodological quality of the psychometric properties of the included studies using the COSMIN guidelines.RESULTS Fifteen studies with instrumented spasticity assessments met all inclusion criteria.Parameters that integrated electrophysiological signals with joint movement characteristics were best able to quantify spasticity. There were conflicting results regarding biomechanicalbased parameters that quantify the resistance to passive stretch. Few methods have been assessed for all psychometric properties. In particular, further information on absolute reliability and responsiveness for more muscles is needed.INTERPRETATION Further research is required to determine the correct parameters for quantifying spasticity based on integration of signals, which especially focuses on distinguishing the neural from non-neural contributions to increased joint torque. These parameters should undergo more rigorous exploration to establish their psychometric properties for use in a clinical environment.Excessive and uncontrolled spasticity causes pain, limits functional recovery, and is thought to cause secondary complications such as contractures and bone deformities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Manually controlled instrumented spasticity assessments: a systematic review of psychometric properties

Bar‐On

Aertbeliën

Molenaers

et al. 2014

Develop Med Child Neuro

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“…EMG normalisation was therefore needed in order to compare the SR amplitude among subjects. This point was crucial, as it has recently been shown that normalisation is essential to correctly interpret the changes following BoNT-A treatment [16].…”

Section: Discussionmentioning

confidence: 99%

Manual Linear Movements to Assess Spasticity in a Clinical Setting

et al. 2013

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In a clinical setting, where motor-driven systems are not readily available, the major difficulty in the assessment of the stretch reflex lies in the control of passive limb displacement velocity. A potential approach to this problem arises from the use of manual sinusoidal movements (made by continuous alternating flexions and extensions) paced by an external stimulus. Unfortunately, there are conditions in which sinusoidal movements induce interfering phenomena such as the shortening reaction or postactivation depression. In the present paper, a novel manual method to control the velocity of passive linear movements is described and the results obtained from both healthy subjects and spastic patients are reported. This method is based on the synchronisation of movements with tones played by a metronome at different speeds. In a first set of experiments performed in healthy subjects, we demonstrated consistent control of velocity during passive limb movements using this method. Four joints usually examined during muscle tone assessment were tested: wrist, elbow, knee and ankle joints. Following this, we conducted a longitudinal assessment of the stretch reflex amplitude in wrist flexor muscles in patients with spasticity treated with botulinum toxin type A. The evaluators were not only able to vary the movement velocity based on the metronome speed, but also could reproduce the respective speeds two weeks later, despite the changing degree of hypertonia. This method is easy to perform in a clinical setting and hardware requirements are minimal, making it an attractive and robust procedure for the widespread clinical assessment of reflex hypertonia.

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“…65 However, both H-reflex and M-max (maximal motor response to electrical stimulation) are known to decrease after BoNTA and the ratio of Hmax/Mmax may not be an appropriate measure of central nervous system change. 66 A better measure is reflex inhibition, and BoNTA injections have been reported to decrease recurrent or Renshaw-cell inhibition in persons post-stroke. 46,67 Although both systemic vascular and axonal spread of the toxin is possible, the prolonged latency in appearance of some AEs such as the distant weakness is uncharacteristic of a mode of vascular toxin spread.…”

Section: Systemic Adverse Events Of Bontamentioning

confidence: 99%

Adverse Clinical Effects of Botulinum Toxin Intramuscular Injections for Spasticity

Phadke

Balasubramanian

Holz

et al. 2015

Can. J. Neurol. Sci.

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Objective: The adverse events (AEs) with botulinum toxin type-A (BoNTA), used for indications other than spasticity, are widely reported in the literature. However, the site, dose, and frequency of injections are different for spasticity when compared to the treatment for other conditions and hence the AEs may be different as well. The objective of this study was to summarize the AEs reported in Canada and systematically review the AEs with intramuscular botulinum toxin injections to treat focal spasticity. Methods: Data were gathered from Health Canada (2009-2013) and major electronic databases. Results: In a 4 year period, 285 AEs were reported. OnabotulinumtoxinA (n = 272 events): 68% females, 53% serious, 18% hospitalization, and 8% fatalities. The type of AEs reported weremuscle weakness (19%), oropharyngeal (14%), respiratory (14%), eye related (8%), bowel/bladder related (8%), and infection (5%). IncobotulinumtoxinA (n = 13): 38% females, 62% serious, and 54% hospitalization. The type of AEs reported were -muscle weakness (15%), oropharyngeal (15%), respiratory (38%), eye related (23%), bowel/bladder related (15%), and infection (15%). Commonly reported AEs in the literature were muscle weakness, pain, oropharyngeal, bowel/bladder, blood circulation, neurological, gait, and respiratory problems. Conclusion: While BoNTA is useful in managing spasticity, future studies need to investigate the factors that can minimize AEs. A better understanding of the underlying mechanisms of the AEs can also improve guidelines for BoNTA administration and enhance outcomes.RÉSUMÉ: Réactions indésirables à des injections intramusculaires de toxine botulique utilisée pour traiter la spasticité. Objectif: Les réactions indésirables (RI) à la toxine botulique de type A (BoNTA) utilisée à des fins autres que le traitement de la spasticité ont été abondamment rapportées dans la littérature. Cependant, le point d'injection, la dose et la fréquence des injections sont différents quand elle est utilisée pour traiter la spasticité par rapport à son utilisation pour traiter d'autres affections et donc les RI peuvent également être différentes. Le but de cette étude était de présenter un sommaire des RI rapportées au Canada et de revoir systématiquement les RI rencontrées lors d'injections intramusculaires de toxine botulique pour traiter la spasticité focale. Méthode: Nous avons recueilli les données de Santé Canada de 2009 à 2013 et ainsi que celles des principales bases de données électroniques. Résultats: Au cours d'une période de 4 ans, 285 RI ont été rapportées, dont 272 RI avec l'onabotulinum toxine A. Soixante-huit pour cent sont survenues chez des femmes, 53% étaient des RI sérieuses, 18% ont nécessité une hospitalisation et 8% ont été fatales. Les RI rapportées étaient de la faiblesse musculaire (19%), des RI oropharyngées (14%), respiratoires (14%), oculaires (8%), en lien à l'intestin / la vessie (8%) et infectieuses (5%). Avec l'incobotulinum toxine A (n = 13) les RI rapportées sont survenues chez des femmes dan...

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Assessing the neurophysiological effects of botulinum toxin treatment for adults with focal limb spasticity: a systematic review

Abstract: Serial electrical nerve stimulation can be incorporated into clinical practice to assist in follow-up. We recommend using M-max and stretch reflex threshold techniques to assess the neurophysiological effects.

Cited by 17 publications

References 59 publications

Manually controlled instrumented spasticity assessments: a systematic review of psychometric properties

Manually controlled instrumented spasticity assessments: a systematic review of psychometric properties

Manual Linear Movements to Assess Spasticity in a Clinical Setting

Adverse Clinical Effects of Botulinum Toxin Intramuscular Injections for Spasticity

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