Tamayo Frances Marie, Rosales Raymond, Wissel Jörg, Biering-Sørensen Bo, Ellano Joshua Nathaniel, Simpson David
Department of Neuroscience and Behavioral Medicine, University of Santo Tomas Hospital, Manila 1015, Philippines.
Research Center for Health Sciences, Faculty of Medicine and Surgery, University of Santo Tomas, Manila 1015, Philippines.
Toxins (Basel). 2025 May 21;17(5):258. doi: 10.3390/toxins17050258.
Spasticity is a common complication associated with stroke, and around 72% of stroke patients will develop pain during the disease. Botulinum toxin (BoNT) is a safe and efficacious treatment for spasticity and can improve associated complications, including pain. Hence, this meta-analysis aims to establish whether BoNT can reduce pain-related post-stroke spasticity (pPSS) in the early treatment period (<12 weeks post-stroke) or in the late period (>12 weeks post-stroke) based on the available evidence. This study also aims to establish the dose-response relationship of BoNT-A in pPSS. Based on pooled data from multiple studies, there is no significant difference in the scores measuring pPSS between patients who received early BoNT-A injections and those who received a placebo. This finding suggests that within the early treatment period, BoNT-A may not be more effective than a placebo in reducing pPSS. However, it is important to note that the data for early BoNT-A injections are limited, indicating that research is needed to draw definitive conclusions [ = 3.90 ( < 0.0001)]. While BoNT-A appears somewhat more effective than a placebo in the late phase, as indicated by the small to moderate positive z value, there is not enough evidence to confidently claim superiority over a placebo [z = 1.48 ( = 0.14)].
痉挛是与中风相关的常见并发症，约72%的中风患者在患病期间会出现疼痛。肉毒杆菌毒素（BoNT）是一种治疗痉挛的安全有效方法，可改善包括疼痛在内的相关并发症。因此，本荟萃分析旨在根据现有证据确定BoNT在中风后早期（中风后<12周）或晚期（中风后>12周）治疗中是否能减轻与疼痛相关的中风后痉挛（pPSS）。本研究还旨在确定BoNT-A在pPSS中的剂量反应关系。基于多项研究的汇总数据，接受早期BoNT-A注射的患者与接受安慰剂的患者在测量pPSS的评分上没有显著差异。这一发现表明，在早期治疗阶段，BoNT-A在减轻pPSS方面可能并不比安慰剂更有效。然而，需要注意的是，早期BoNT-A注射的数据有限，这表明需要进行研究才能得出明确结论[=3.90（<0.0001）]。虽然如小到中度的正z值所示，BoNT-A在后期似乎比安慰剂更有效，但没有足够的证据可以自信地宣称其优于安慰剂[z=1.48（=0.14）]。
