Botulinum Toxin Dilution and Endplate Targeting in Spasticity: A Double-Blind Controlled Study

Does Spasticity Reduction by Botulinum Toxin Type A Improve Upper Limb Functionality in Adult Post-Stroke Patients? A Systematic Review of Relevant Studies

“…Of these, 17 were excluded due to exclusion criteria: i) one trial in which post stroke spasticity was treated by botulinum toxin type B (rimabotulinumtoxinB) [21]; ii) three trial that evaluated the effect of BTX-A given early post stroke before clinically evident spasticity [22][23][24]; iii) one trial that studied the effect of BTX-A dilution and endplate-targeting in sole spastic biceps [25]; iv) five trials enrolling mixed sample of subjects with spasticity secondary to brain injury, multiple sclerosis other than stroke [9,[26][27][28][29]; v) six studies focusing the effect of BTX-A on the reduction of pain associated to spastic shoulder [30][31][32][33][34][35] and one trial that investigated the effects of BTX-A on associated reactions of spasticity [36]. The remaining 17 RTs were included [11,13,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review

“…In addition, complete description of the intervention including concentration, dosing, muscle selection, muscle or nerve method of localization is crucial, so as to enable comparisons across studies. There is evidence from at least one RCT that BoNT dilution 48 can affect outcomes. Also, the sole use of anatomical landmarks has been shown to be inferior to electromyography plus anatomy for muscle localization, 49 therefore should be avoided when possible both in the research and clinical setting.…”

Clostridial neurotoxins

“…Intramuscular spread of BoNT allows the toxin to reach distant nerve endings within large muscles. This effect is desirable when botulinum toxin is injected into large muscles [272], in which the location of the motor endplates is very scattered [273,274].…”