D.L. KLABUKOVA, V.S. KRYSANOVA, T.N. ERMOLAEVA, M.V. DAVYDOVSKAYA

¹Scientific and Research Institute of Healthcare and Medical Management Organization, Department of Healthcare of the city of Moscow, Moscow

²Russian National Research Medical University named after N.I. Pirogov, Ministry of Healthcare of the Russian Federation, Moscow

Contact details:

Klabukova D.L. — Ph. D. (biology), Leading Researcher

Address: 8 Sharikopodshipnikovskaya St., Moscow, Russian Federation, 115088, tel.: +7 (495) 530-12-89, e-mail: daria.klabukova@gmail.com

Spasticity is one of the most common complications after stroke and has a significant impact on the patient’s quality of life. One of the methods for controlling this condition is the injection of focal muscle relaxants based on botulinum toxin type A (BTX-A). The high similarity of clinical results when using various BTX-A drugs makes the systematization and comparative evaluation of modern data on their use relevant.

The purpose — systematic review was to evaluate the efficacy and safety of botulinum toxin type A, hemagglutinin (aboBoNT-A), in the treatment of post-stroke upper limb spasticity (ULS).

Material and methods. The search was conducted in December 2018 for the terms MeSH «botulinum toxin a», «spasticity» and «upper limb» in the Embase, Medline, Cochrane and eLIBRARY.ru databases. Search criteria were defined in accordance with the PICO(S) scheme. Publications date range was 10 years. The selection of publications was carried out in accordance with the PRISMA guidelines. The levels of credibility and evidence of selected studies were determined.

Results. Total of 1382 publications were identified, 189 studies were selected, of which 7 were included in the final review. The efficacy of aboBoNT-A has been confirmed compared to placebo from 1 week of therapy with the effect remaining up to 20 weeks. Results were more significant in the scores of muscle tone (according to the Modified Ashworth Scale), passive function (according to the Disability Assessment Scale) and clinical benefit evaluated by a doctor (Physician’s Global Assessment), and less significant in the assessments of active function of the upper limb and functional abilities. The safety profile of an aboBoNT-A injection is consistent with known data for BoNT-A. Adverse effects (AEs) were from mild to moderate grade. None of the serious AEs cases or deaths was related to the therapy. Early administration of aboBoNT-A, within 2-12 weeks after a stroke, also had led to a decrease in muscle tone and delayed onset of symptoms compared to placebo and good tolerance maintaining.

Conclusions. Evidence of the efficacy and safety of aboBoNT-A for patients with ULS after a stroke is considered convincing with recommendations level A.

Key words: botulinum toxin type A, post-stroke spasticity, upper limb, efficacy, safety.

(For citation: Klabukova D.L., Krysanova V.S., Ermolaeva T.N., Davydovskaya M.V. Systematic review of the use of botulinum toxin type A during treatment of post-stroke spasticity of the upper limb. Practical Medicine. 2019. Vol. 17, № 7, P. 38-45) 

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