Abstract
Objective
To conduct a systematic review of the literature that examined the effect of botulinum
toxin type A on clonus.
Data Sources
A literature search of multiple databases (PubMed, Cochrane, Google Scholar, Embase)
was performed to identify articles published in English in the past 30 years (1986–2016).
Study Selection
Two reviewers independently applied the following inclusion criteria: (1) any adult
patients older than 18 years with upper motor lesion; (2) any location and duration
of clonus; and (3) subjective and objective measurements of clonus tested at least
2 weeks after botulinum toxin injection.
Data Extraction
Two reviewers independently extracted the data and assessed the methodological quality.
A consensus method was used to solve disagreements.
Data Synthesis
The systematic review resulted in 164 articles, of which 14 met the inclusion criteria:
3 were randomized controlled trials, 1 was nonrandomized, and 6 were case series and
3 case studies. All studies (181 patients) showed improvement in clonus: 6 of 14 results
were statistically significant. Different scales were used for clonus measurement,
such as clonus score, patient diaries, clonus spasm score, and electromyogram duration.
Conclusions
Overall, there was preliminary evidence indicating improvement in clonus after botulinum
injection. The major drawback with studies reviewed here was a large variation in
the type of clonus assessment tools, which also lacked validity, reliability, and
sensitivity to small changes in clonus.
Keywords
List of abbreviations:
BoNTA (botulinum toxin type A), EMG (electromyogram), LOE (level of evidence), UMN (upper motor neuron)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 24, 2016
Footnotes
Supported by the West Park Foundation.
Disclosures: C.P.P., F.I., and C.B. have received research grants from Allergan and Merz. F.I. and C.B. have received speaker fees and honoraria from Allergan and Merz.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
