Article

OBJECTIVE: To conduct a systematic review of the impact of different
injection-guiding techniques on the effectiveness of botulinum toxin type A
(BoNT-A) for the treatment of focal spasticity and dystonia. DATA SOURCES: MEDLINE via PubMed, Academic Search Premier, PASCAL,
The Cochrane Library,
Scopus, SpringerLink, Web of Science, EM Premium, and PsycINFO. STUDY SELECTION:
Two reviewers independently selected studies based on predetermined inclusion
criteria. DATA EXTRACTION: Data relating to the aim were extracted.
Methodological quality was graded independently by 2 reviewers using the
Physiotherapy Evidence Database assessment scale for randomized controlled trials
(RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence
was determined using the modified Sackett scale. DATA SYNTHESIS: Ten studies were
included. Seven were randomized. There was strong evidence (level 1) that
instrumented guiding (ultrasonography [US], electrical stimulation [ES],
electromyogram [EMG]) was more effective than manual needle placement for the
treatment of spasmodic torticollis, upper limb spasticity, and spastic equinus in
patients with stroke, and spastic equinus in children with cerebral palsy. Three
studies provided strong evidence (level 1) of similar effectiveness of US and ES
for upper and lower limb spasticity in patients with stroke, and spastic equinus
in children with cerebral palsy, but there was poor evidence or no available
evidence for EMG or other instrumented techniques. CONCLUSIONS: These results
strongly recommend instrumented guidance of BoNT-A injection for the treatment of
spasticity in adults and children (ES or US), and of focal dystonia such as
spasmodic torticollis (EMG). No specific recommendations can be made regarding
the choice of instrumented guiding technique, except that US appears to be more
effective than ES for spastic equinus in adults with stroke.
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Langue : ANGLAIS