Evidence map›Paper›PMID 16454533›Full record

ReviewDrug safety2006

Botulinum toxin treatment of adult spasticity : a benefit-risk assessment.

Geoffrey Sheean

Abstract readReview
PubMed Publisher
In one paragraph

Review in Drug safety, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 2 pooled it
4.8field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 78 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Trial
  4. Trial
  5. Trial
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Retraining Reflexes: Clinical Translation of Spinal Reflex Operant Conditioning.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2018
    Review
  13. Patient Registry of Spasticity Care World: Data Analysis Based on Physician Experience.American journal of physical medicine & rehabilitation · 2017
    Observational
  14. Restoring walking after spinal cord injury: operant conditioning of spinal reflexes can help.The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry · 2015
    Review
  15. Article
  16. Targeted neuroplasticity for rehabilitation.Progress in brain research · 2015
    Review
  17. Botulinum toxin for symptomatic therapy in multiple sclerosis.Current neurology and neuroscience reports · 2014
    Review
  18. Article
  19. Review
  20. Operant conditioning of a spinal reflex can improve locomotion after spinal cord injury in humans.The Journal of neuroscience : the official journal of the Society for Neuroscience · 2013
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

1 author at 1 institution in 1 country.

Geoffrey SheeanUniversity of California, San Diego, California 92103-8465, USA. gssheean@ucsd.edu
University of California, San Diego · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Injections of botulinum toxin have revolutionised the treatment of focal spasticity. Before their advent, the medical treatment for focal spasticity involved oral anti-spasticity drugs, which had decidedly non-focal adverse effects, and phenol injections. Phenol injections could be difficult to perform, could cause sensory complications and had effects that were of uncertain duration and magnitude. Furthermore, few neurologists knew how to perform them as they were mostly the province of rehabilitation specialists. Botulinum toxin can produce focal, controllable muscle weakness of predictable duration, without sensory adverse effects. Randomised clinical trials (RCTs) involving patients with spasticity resulting from a variety of diseases (mainly stroke and multiple sclerosis) have clearly shown that botulinum toxin type A (Dysport and Botox) can temporarily (for approximately 3 months) reduce spastic hypertonia in the elbow, wrist and finger flexors of the upper limbs, and the hip adductors and ankle plantar flexors in the lower limbs. The clinical benefits from this reduction of neurological impairment are best shown in the upper limb, with less disability of passive function and reduced caregiver burden. In the lower limbs, there is improved perineal hygiene from hip adductor injections. The benefits of reducing ankle plantar flexor tone are less well established. Pain is also reduced, possibly by mechanisms other than muscle weakness. Improved active function has not yet been clearly demonstrated in RCTs, only in open-label trials. The safety of botulinum toxin-A is impressive, with minimal (mainly local) adverse effects. There are little data on the use of botulinum toxin type B (Myobloc or Neurobloc) in spasticity and the only RCT that has examined this did not show tone reduction; dry mouth appeared to be a very common adverse effect. There are also very little data to allow a benefit-risk comparison of phenol and botulinum toxin injections; each have their clinical and technical advantages and disadvantages, and phenol is much less costly than botulinum toxin.

Indexed as

AdultBotulinum ToxinsBotulinum Toxins, Type AHumansMotor Neuron DiseaseMuscle SpasticityNeuromuscular AgentsRandomized Controlled Trials as TopicRisk AssessmentBotulinum ToxinsBotulinum Toxins, Type ANeuromuscular AgentsrimabotulinumtoxinB

Identifiers

PMID16454533
OpenAlexW2002794640

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.