Botulinum Toxin in Pain-Related Post-Stroke Limb Spasticity: A Meta-Analysis of Early and Late Injections
Abstract
:1. Background
2. Methods
3. Information Sources
4. Search Terms and Assessment
5. Characteristics of Studies and Synthesis of Results
6. Results
7. Analysis of Early BoNT Injections for Treating pPSS
8. Analysis of Late BoNT-A Injections for Treating pPSS
9. Dose–Response Relationship of BoNT Injections and Pain Scores
10. Discussion
11. Limitations and Future Directions
12. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author (Year) | Level of Evidence | Population | Ictus | Botulinum Injection Dose | Control | Pain Scale Applied |
---|---|---|---|---|---|---|
Early Injections (Less than or Equal to 12 weeks) | ||||||
Rosales et al. (2012) | Multicenter Randomized Placebo-Controlled Trial | 163 patients with mild to severe upper limb spasticity | 12 weeks | AbobotulinumtoxinA 500 U uniform dose | 2.5 mL of Normal saline | VAS |
Rosales et al. (2018) | Randomized Double-Blind Placebo-Controlled Trial | 42 patients with upper limb spasticity | 2–12 weeks | AbobotulinumtoxinA 500 U uniform dose | 2.5 mL of Normal Saline | PNRS |
Seo et al. (2015) | Randomized Controlled Trial | 196 patients with moderate to severe upper limb spasticity | 6 weeks | Neu-BoNT-A 10 U–360 U | BoNT-A 100 U | DAS-Pain |
Late Injections (More than 12 weeks) | ||||||
Bakheit et al. (2000) | Randomized Double-Blind Placebo-Controlled Dose-Ranging Trial | 83 patients with moderate to severe upper limb spasticity | >3 months | AbobotulinumtoxinA 500 U, 1000 U and 1500 U | 2 mL of Normal saline | 4-Point Pain Scale a |
Kong et al. (2007) | Randomized Double-Blind Placebo-Controlled Trial | 17 patients with shoulder spasticity | >3 months | AbobotulinumtoxinA 250 U and 500 U | 2.5 mL of Normal saline | VAS |
Marciniak et al. (2012) | Randomized Double-Blind Placebo-Controlled Trial | 21 patients with shoulder spasticity | 28.8 months | AbobotulinumtoxinA 100 U and 150 U | 1–1.5 mL of Normal Saline | MPQ-SF |
Marco et al. (2007) | Double-Blind Randomized Clinical Trial | 14 patients with shoulder spasticity | >3 months | AbobotulinumtoxinA 500 U | 2.5 mL of Normal Saline | VAS |
Shaw et al. (2015) | Multicenter Parallel Group Randomized Placebo-Controlled Trial | 333 patients with upper limb spasticity | >1 month | AbobotulinumtoxinA 100 or 200 U | Standard Upper Limb Therapy | Pain Score Pain Description |
Wissel et al. (2016) | Multicenter Randomized Double-Blind Placebo-Controlled Trial | 273 patients with upper and lower limb spasticity | >12 weeks | OnabotulinumtoxinA 340–365 U | Normal Saline | PNRS |
Tan et al. (2021) | Randomized Double-Blind Placebo-Controlled Trial | 36 Patients with shoulder spasticity | >2 months | OnabotulinumtoxinA 50 U-100 U | 2.0 mL of Normal Saline | VAS |
Yelnik et al. (2007) | Randomized Double-Blind Placebo-Controlled Two Parallel Group Study | 20 patients with shoulder spasticity | 224 days | AbobotulinumtoxinA 500 U | BoNT-A solvent | VAS |
Masakado et al. (2020) | Randomized Double-Blind Placebo-Controlled Study | 100 patients with unilateral post-stroke upper limb spasticity | >16 weeks | IncobotulinumtoxinA 400 U | Injection Diluent 50 U/mL | DAS |
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Tamayo, F.M.; Rosales, R.; Wissel, J.; Biering-Sørensen, B.; Ellano, J.N.; Simpson, D. Botulinum Toxin in Pain-Related Post-Stroke Limb Spasticity: A Meta-Analysis of Early and Late Injections. Toxins 2025, 17, 258. https://doi.org/10.3390/toxins17050258
Tamayo FM, Rosales R, Wissel J, Biering-Sørensen B, Ellano JN, Simpson D. Botulinum Toxin in Pain-Related Post-Stroke Limb Spasticity: A Meta-Analysis of Early and Late Injections. Toxins. 2025; 17(5):258. https://doi.org/10.3390/toxins17050258
Chicago/Turabian StyleTamayo, Frances Marie, Raymond Rosales, Jörg Wissel, Bo Biering-Sørensen, Joshua Nathaniel Ellano, and David Simpson. 2025. "Botulinum Toxin in Pain-Related Post-Stroke Limb Spasticity: A Meta-Analysis of Early and Late Injections" Toxins 17, no. 5: 258. https://doi.org/10.3390/toxins17050258
APA StyleTamayo, F. M., Rosales, R., Wissel, J., Biering-Sørensen, B., Ellano, J. N., & Simpson, D. (2025). Botulinum Toxin in Pain-Related Post-Stroke Limb Spasticity: A Meta-Analysis of Early and Late Injections. Toxins, 17(5), 258. https://doi.org/10.3390/toxins17050258