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

Study design: Systematic review. Objectives: To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI). Setting: British Columbia, Canada. Methods: EMBASE, MEDLINE, CINAHL, Cochrane Da...

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Veröffentlicht in:Spinal cord 2015-04, Vol.53 (4), p.252-264
Hauptverfasser: Lui, J, Sarai, M, Mills, P B
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description Study design: Systematic review. Objectives: To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI). Setting: British Columbia, Canada. Methods: EMBASE, MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched for English language studies published up until March 2014. Studies were assessed for eligibility and quality by two independent reviewers. Results: No controlled trials were identified. A total of 19 studies were included: 9 involving BoNT and 10 involving phenol/alcohol. Owing to the clinically diverse nature of the studies, meta-analysis was deemed inappropriate. The studies produced level 4 and level 5 evidence that chemodenervation with BoNT or alcohol/phenol can lead to improvement in outcome measurements classified in the body structure and function, as well as activity domains of the International Classification of Functioning, Disability and Health framework. The Modified Ashworth Scale (MAS) was the most commonly used outcome measure. All six studies on BoNT and three of the four studies on phenol/alcohol measuring MAS reported a decrease in at least one point. An improvement in MAS was not always associated with improvement in function. The effect of phenol/alcohol has the potential to last beyond 6 months; study follow-up did not occur beyond this time point. Conclusion Chemodenervation with BoNT or phenol/alcohol may improve spasticity and function in individuals with SCI. However, there is a lack of high-quality evidence and further research is needed to confirm the efficacy of these interventions.
doi_str_mv 10.1038/sc.2014.241
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Objectives: To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI). Setting: British Columbia, Canada. Methods: EMBASE, MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched for English language studies published up until March 2014. Studies were assessed for eligibility and quality by two independent reviewers. Results: No controlled trials were identified. A total of 19 studies were included: 9 involving BoNT and 10 involving phenol/alcohol. Owing to the clinically diverse nature of the studies, meta-analysis was deemed inappropriate. The studies produced level 4 and level 5 evidence that chemodenervation with BoNT or alcohol/phenol can lead to improvement in outcome measurements classified in the body structure and function, as well as activity domains of the International Classification of Functioning, Disability and Health framework. The Modified Ashworth Scale (MAS) was the most commonly used outcome measure. All six studies on BoNT and three of the four studies on phenol/alcohol measuring MAS reported a decrease in at least one point. An improvement in MAS was not always associated with improvement in function. The effect of phenol/alcohol has the potential to last beyond 6 months; study follow-up did not occur beyond this time point. Conclusion Chemodenervation with BoNT or phenol/alcohol may improve spasticity and function in individuals with SCI. However, there is a lack of high-quality evidence and further research is needed to confirm the efficacy of these interventions.</description><identifier>ISSN: 1362-4393</identifier><identifier>EISSN: 1476-5624</identifier><identifier>DOI: 10.1038/sc.2014.241</identifier><identifier>PMID: 25582713</identifier><identifier>CODEN: SPCOFM</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/1807/1693 ; 692/699/375/1824 ; Anatomy ; Anesthetics - adverse effects ; Anesthetics - therapeutic use ; Biomedical and Life Sciences ; Biomedicine ; Botulinum Toxins, Type A - adverse effects ; Botulinum Toxins, Type A - therapeutic use ; Clinical Studies as Topic ; Ethanol - adverse effects ; Ethanol - therapeutic use ; Human Physiology ; Humans ; Muscle Spasticity - drug therapy ; Muscle Spasticity - etiology ; Muscle Spasticity - physiopathology ; Nerve Block - adverse effects ; Nerve Block - methods ; Neurochemistry ; Neuropsychology ; Neurosciences ; Phenol - adverse effects ; Phenol - therapeutic use ; review ; Spinal Cord Injuries - complications ; Spinal Cord Injuries - physiopathology</subject><ispartof>Spinal cord, 2015-04, Vol.53 (4), p.252-264</ispartof><rights>International Spinal Cord Society 2015</rights><rights>Copyright Nature Publishing Group Apr 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-b41939b7d0613904be5e759e30b4e280c689d861dde025259a85cdabafd9348e3</citedby><cites>FETCH-LOGICAL-c494t-b41939b7d0613904be5e759e30b4e280c689d861dde025259a85cdabafd9348e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25582713$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lui, J</creatorcontrib><creatorcontrib>Sarai, M</creatorcontrib><creatorcontrib>Mills, P B</creatorcontrib><title>Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review</title><title>Spinal cord</title><addtitle>Spinal Cord</addtitle><addtitle>Spinal Cord</addtitle><description>Study design: Systematic review. Objectives: To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI). Setting: British Columbia, Canada. Methods: EMBASE, MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched for English language studies published up until March 2014. Studies were assessed for eligibility and quality by two independent reviewers. Results: No controlled trials were identified. A total of 19 studies were included: 9 involving BoNT and 10 involving phenol/alcohol. Owing to the clinically diverse nature of the studies, meta-analysis was deemed inappropriate. The studies produced level 4 and level 5 evidence that chemodenervation with BoNT or alcohol/phenol can lead to improvement in outcome measurements classified in the body structure and function, as well as activity domains of the International Classification of Functioning, Disability and Health framework. The Modified Ashworth Scale (MAS) was the most commonly used outcome measure. All six studies on BoNT and three of the four studies on phenol/alcohol measuring MAS reported a decrease in at least one point. An improvement in MAS was not always associated with improvement in function. The effect of phenol/alcohol has the potential to last beyond 6 months; study follow-up did not occur beyond this time point. Conclusion Chemodenervation with BoNT or phenol/alcohol may improve spasticity and function in individuals with SCI. 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Objectives: To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI). Setting: British Columbia, Canada. Methods: EMBASE, MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched for English language studies published up until March 2014. Studies were assessed for eligibility and quality by two independent reviewers. Results: No controlled trials were identified. A total of 19 studies were included: 9 involving BoNT and 10 involving phenol/alcohol. Owing to the clinically diverse nature of the studies, meta-analysis was deemed inappropriate. The studies produced level 4 and level 5 evidence that chemodenervation with BoNT or alcohol/phenol can lead to improvement in outcome measurements classified in the body structure and function, as well as activity domains of the International Classification of Functioning, Disability and Health framework. The Modified Ashworth Scale (MAS) was the most commonly used outcome measure. All six studies on BoNT and three of the four studies on phenol/alcohol measuring MAS reported a decrease in at least one point. An improvement in MAS was not always associated with improvement in function. The effect of phenol/alcohol has the potential to last beyond 6 months; study follow-up did not occur beyond this time point. Conclusion Chemodenervation with BoNT or phenol/alcohol may improve spasticity and function in individuals with SCI. However, there is a lack of high-quality evidence and further research is needed to confirm the efficacy of these interventions.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>25582713</pmid><doi>10.1038/sc.2014.241</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record>
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692/699/375/1824
Anatomy
Anesthetics - adverse effects
Anesthetics - therapeutic use
Biomedical and Life Sciences
Biomedicine
Botulinum Toxins, Type A - adverse effects
Botulinum Toxins, Type A - therapeutic use
Clinical Studies as Topic
Ethanol - adverse effects
Ethanol - therapeutic use
Human Physiology
Humans
Muscle Spasticity - drug therapy
Muscle Spasticity - etiology
Muscle Spasticity - physiopathology
Nerve Block - adverse effects
Nerve Block - methods
Neurochemistry
Neuropsychology
Neurosciences
Phenol - adverse effects
Phenol - therapeutic use
review
Spinal Cord Injuries - complications
Spinal Cord Injuries - physiopathology
title Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review
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