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 |
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| creator | Lui, J Sarai, M Mills, P B |
| 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 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1685748654</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3650505881</sourcerecordid><originalsourceid>FETCH-LOGICAL-c494t-b41939b7d0613904be5e759e30b4e280c689d861dde025259a85cdabafd9348e3</originalsourceid><addsrcrecordid>eNqN0c1rFDEYBvAgiv3QU-8S8CK0s-Z7kt5ksa1Q8KLnIZO8U7PMTLZJpmX_e7NsLSI9eEpIfjwvLw9CZ5SsKOH6c3YrRqhYMUFfoWMqWtVIxcTreueKNYIbfoROct4QQgw1-i06YlJq1lJ-jNz6F0zRwwzpwZYQZzzEhEsCWyaYC44DHsPU47y1uQQXyq6CcYyPYb6rj2G2I3YxeRzmzZJ2l9jivMsFphrmcIKHAI_v0JvBjhneP52n6OfV1x_rm-b2-_W39ZfbxgkjStMLarjpW08U5YaIHiS00gAnvQCmiVPaeK2o90CYZNJYLZ23vR284UIDP0WfDrnbFO8XyKWbQnYwjnaGuOSOKi1boZUU_0M5l4ISUunHf-gmLqnuvVcto0QpSas6PyiXYs4Jhm6bwmTTrqOk29fUZdfta-pqTVV_eMpc-gn8s_3TSwUXB5Dr13wH6a-hL-T9BmEom88</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1672106651</pqid></control><display><type>article</type><title>Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Lui, J ; Sarai, M ; Mills, P B</creator><creatorcontrib>Lui, J ; Sarai, M ; Mills, P B</creatorcontrib><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.</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. However, there is a lack of high-quality evidence and further research is needed to confirm the efficacy of these interventions.</description><subject>692/1807/1693</subject><subject>692/699/375/1824</subject><subject>Anatomy</subject><subject>Anesthetics - adverse effects</subject><subject>Anesthetics - therapeutic use</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Botulinum Toxins, Type A - adverse effects</subject><subject>Botulinum Toxins, Type A - therapeutic use</subject><subject>Clinical Studies as Topic</subject><subject>Ethanol - adverse effects</subject><subject>Ethanol - therapeutic use</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Muscle Spasticity - drug therapy</subject><subject>Muscle Spasticity - etiology</subject><subject>Muscle Spasticity - physiopathology</subject><subject>Nerve Block - adverse effects</subject><subject>Nerve Block - methods</subject><subject>Neurochemistry</subject><subject>Neuropsychology</subject><subject>Neurosciences</subject><subject>Phenol - adverse effects</subject><subject>Phenol - therapeutic use</subject><subject>review</subject><subject>Spinal Cord Injuries - complications</subject><subject>Spinal Cord Injuries - physiopathology</subject><issn>1362-4393</issn><issn>1476-5624</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqN0c1rFDEYBvAgiv3QU-8S8CK0s-Z7kt5ksa1Q8KLnIZO8U7PMTLZJpmX_e7NsLSI9eEpIfjwvLw9CZ5SsKOH6c3YrRqhYMUFfoWMqWtVIxcTreueKNYIbfoROct4QQgw1-i06YlJq1lJ-jNz6F0zRwwzpwZYQZzzEhEsCWyaYC44DHsPU47y1uQQXyq6CcYyPYb6rj2G2I3YxeRzmzZJ2l9jivMsFphrmcIKHAI_v0JvBjhneP52n6OfV1x_rm-b2-_W39ZfbxgkjStMLarjpW08U5YaIHiS00gAnvQCmiVPaeK2o90CYZNJYLZ23vR284UIDP0WfDrnbFO8XyKWbQnYwjnaGuOSOKi1boZUU_0M5l4ISUunHf-gmLqnuvVcto0QpSas6PyiXYs4Jhm6bwmTTrqOk29fUZdfta-pqTVV_eMpc-gn8s_3TSwUXB5Dr13wH6a-hL-T9BmEom88</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Lui, J</creator><creator>Sarai, M</creator><creator>Mills, P B</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review</title><author>Lui, J ; Sarai, M ; Mills, P B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-b41939b7d0613904be5e759e30b4e280c689d861dde025259a85cdabafd9348e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>692/1807/1693</topic><topic>692/699/375/1824</topic><topic>Anatomy</topic><topic>Anesthetics - adverse effects</topic><topic>Anesthetics - therapeutic use</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Botulinum Toxins, Type A - adverse effects</topic><topic>Botulinum Toxins, Type A - therapeutic use</topic><topic>Clinical Studies as Topic</topic><topic>Ethanol - adverse effects</topic><topic>Ethanol - therapeutic use</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Muscle Spasticity - drug therapy</topic><topic>Muscle Spasticity - etiology</topic><topic>Muscle Spasticity - physiopathology</topic><topic>Nerve Block - adverse effects</topic><topic>Nerve Block - methods</topic><topic>Neurochemistry</topic><topic>Neuropsychology</topic><topic>Neurosciences</topic><topic>Phenol - adverse effects</topic><topic>Phenol - therapeutic use</topic><topic>review</topic><topic>Spinal Cord Injuries - complications</topic><topic>Spinal Cord Injuries - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lui, J</creatorcontrib><creatorcontrib>Sarai, M</creatorcontrib><creatorcontrib>Mills, P B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Spinal cord</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lui, J</au><au>Sarai, M</au><au>Mills, P B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review</atitle><jtitle>Spinal cord</jtitle><stitle>Spinal Cord</stitle><addtitle>Spinal Cord</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>53</volume><issue>4</issue><spage>252</spage><epage>264</epage><pages>252-264</pages><issn>1362-4393</issn><eissn>1476-5624</eissn><coden>SPCOFM</coden><abstract>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.</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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| subjects | 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 |
| title | Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review |
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