Domenico Intiso, Valentina Simone, Filomena Di Rienzo, Andrea Santamato, Mario Russo, Maurizio Tolfa and Mario Basciani
Objective: Botulinum toxin type A (BTX-A) use reduces upper limb (UL) spasticity in stroke patients, but the effects
on functional recovery remain uncertain. The aim of present review was to ascertain if the reduction of spasticity by
use of BTX-A was linked to a functional gain of UL or in activity of daily living in post-stroke patients.
Data source: Search of relevant studies was conducted on MEDLINE, the Cochrane Central Register of
Controlled Trials and EMBASE (1995 to July 2012).
Study selection: Only randomized studies (RT) treating patients with UL post-stroke spasticity by BTX-A injection
were included. Prospective open label, case series, cohort studies and case reports were excluded.
Data synthesis: Thirty-four RTs were individuated, but only 16 were considered in the analysis. Trials varied
widely in methodological design and measures used in assessing UL ability. Benefit in UL functional recovery was
reported in 13 studies, but only in six the result was significant.
Conclusion: some oriented-focused movements of UL unequivocally improve after reduced spasticity by BTX-A
treatment, but evidence that arm functionality in adult post-stroke patients significantly benefit from this intervention is
still doubt. No improvement in global functionality of activity daily living was observed.
