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Asimakidou E, Sidiropoulos C. A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity. Toxins (Basel) 2023; 15:toxins15040256. [PMID: 37104194 PMCID: PMC10145352 DOI: 10.3390/toxins15040256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Accurate targeting of overactive muscles is fundamental for successful botulinum neurotoxin (BoNT) injections in the treatment of spasticity. The necessity of instrumented guidance and the superiority of one or more guidance techniques are ambiguous. Here, we sought to investigate if guided BoNT injections lead to a better clinical outcome in adults with limb spasticity compared to non-guided injections. We also aimed to elucidate the hierarchy of common guidance techniques including electromyography, electrostimulation, manual needle placement and ultrasound. To this end, we conducted a Bayesian network meta-analysis and systematic review with 245 patients using the MetaInsight software, R and the Cochrane Review Manager. Our study provided, for the first time, quantitative evidence supporting the superiority of guided BoNT injections over the non-guided ones. The hierarchy comprised ultrasound on the first level, electrostimulation on the second, electromyography on the third and manual needle placement on the last level. The difference between ultrasound and electrostimulation was minor and, thus, appropriate contextualization is essential for decision making. Taken together, guided BoNT injections based on ultrasound and electrostimulation performed by experienced practitioners lead to a better clinical outcome within the first month post-injection in adults with limb spasticity. In the present study, ultrasound performed slightly better, but large-scale trials should shed more light on which modality is superior.
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Lin YC, Wu WT, Hsu YC, Han DS, Chang KV. Comparative effectiveness of botulinum toxin versus non-surgical treatments for treating lateral epicondylitis: a systematic review and meta-analysis. Clin Rehabil 2017; 32:131-145. [DOI: 10.1177/0269215517702517] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives: To explore the effectiveness of botulinum toxin compared with non-surgical treatments in patients with lateral epicondylitis. Methods: Data sources including PubMed, Scopus, Embase and Airity Library from the earliest record to February 2017 were searched. Study design, patients’ characteristics, dosage/brand of botulinum toxin, injection techniques, and measurements of pain and hand grip strength were retrieved. The standardized mean differences (SMDs) in pain relief and grip strength reduction were calculated at the following time points: 2-4, 8-12, and 16 weeks or more after injection. Results: Six randomized controlled trials (321 participants) comparing botulinum toxin with placebo or corticosteroid injections were included. Compared with placebo, botulinum toxin injection significantly reduced pain at all three time points (SMD, -0.729, 95% confidence interval [CI], -1.286 to -0.171; SMD, -0.446, 95% CI, -0.740 to -0.152; SMD, -0.543, 95% CI, -0.978 to -0.107, respectively). Botulinum toxin was less effective than corticosteroid at 2-4 weeks (SMD, 1.153; 95% CI, 0.568-1.737) and both treatments appeared similar in efficacy after 8 weeks. Different injection sites and dosage/brand did not affect effectiveness. Botulinum toxin decreased grip strength 2-4 weeks after injection, and high equivalent dose could extend its paralytic effects to 8-12 weeks. Conclusions: When treating lateral epicondylitis, botulinum toxin was superior to placebo and could last for 16 weeks. Corticosteroid and botulinum toxin injections were largely equivalent, except the corticosteroid injections were better at pain relief in the early stages and were associated with less weakness in grip in the first 12 weeks.
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Affiliation(s)
- Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, UK
| | - Yu-Chun Hsu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, UK
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, UK
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
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Lin IL, Li PC, Chiu YT, Lin YC. Re: Lim et al. injection of botulinum toxin to the extensor carpi radialis brevis for tennis elbow. J Hand Surg Eur Vol 2011; 36:83-4; author reply 84. [PMID: 21169311 DOI: 10.1177/1753193410383600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- I-Ling Lin
- Faculty of Biomedical Laboratory Science and Department of Plastic Surgery, Kaohsiung Medical University; Department of Occupational Therapy and Department of Physical Therapy, I-Shou University; and Department of Physical Medicine and Rehabilitation, E-Da Hospital, Kaohsiung, Taiwan
| | - Ping Chia Li
- Faculty of Biomedical Laboratory Science and Department of Plastic Surgery, Kaohsiung Medical University; Department of Occupational Therapy and Department of Physical Therapy, I-Shou University; and Department of Physical Medicine and Rehabilitation, E-Da Hospital, Kaohsiung, Taiwan
| | - Yu-Te Chiu
- Faculty of Biomedical Laboratory Science and Department of Plastic Surgery, Kaohsiung Medical University; Department of Occupational Therapy and Department of Physical Therapy, I-Shou University; and Department of Physical Medicine and Rehabilitation, E-Da Hospital, Kaohsiung, Taiwan
| | - Yu Ching Lin
- Faculty of Biomedical Laboratory Science and Department of Plastic Surgery, Kaohsiung Medical University; Department of Occupational Therapy and Department of Physical Therapy, I-Shou University; and Department of Physical Medicine and Rehabilitation, E-Da Hospital, Kaohsiung, Taiwan
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