SynthesisToxins2023
A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity.
Synthesis in Toxins, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled 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.
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.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- From Neurophysiological Mechanisms to Rehabilitation After Botulinum Toxin Type A in Post-Stroke Spasticity.Toxins · 2026Pooled it
- Population-Based Quantitative Spatial Mapping of Ulnar Motor Branch Origins in the Forearm: An Integrated Anatomical Reference Framework.Diagnostics (Basel, Switzerland) · 2026Article
- Forearm Supination Increases the Safety Corridor and Target Exposure for Ultrasound-Guided Flexor Pollicis Longus Injection: A Prospective Study in Healthy Adults.Diagnostics (Basel, Switzerland) · 2026Article
- Non-Invasive Assessment of Hypertonic Muscle Properties After Botulinum Toxin Neuromodulation in Post-Stroke Patients: A Systematic Literature Review of Recent Evidence (2023-2025) on Mobility and Balance.Life (Basel, Switzerland) · 2026Review
- Review
- Evolution of goal setting and attainment over repeated cycles of botulinum toxin A for upper limb spasticity in real-life clinical practice: longitudinal analyses from the observational ULIS-III cohort study.Journal of rehabilitation medicine · 2026Observational
- Localization modalities for botulinum neurotoxin injection.Toxicon : official journal of the International Society on Toxinology · 2025Review
- Ultrasound-Guided Botulinum Toxin Injections for Hand Spasticity: A Technical Guide for the Dorsal Approach.Toxins · 2025Article
- Ultrasound-Guided Botulinum Toxin Infiltrations in Essential Tremor Patients: A 36-week Follow Up.Tremor and other hyperkinetic movements (New York, N.Y.) · 2025Article
- Article
- Article
- Article
- The Role of Botulinum Toxin Type-A in Spasticity: Research Trends from a Bibliometric Analysis.Toxins · 2024Review
- Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review.Toxins · 2024Article
- Article
- Advances in the diagnosis and management of post-stroke limb spasticity: a narrative review.Frontiers in neurologyReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
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.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.