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Botulinum Toxin Injection for Treating Spasticity in Multiple Sclerosis Patients: A Systematic Review and Meta-Analysis Publisher



Emami Razavi SZ1 ; Azadvari M2 ; Mirmosayyeb O3, 4 ; Vaheb S3 ; Ghajarzadeh M5 ; Teymouri A6 ; Hosseini M1
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Authors Affiliations
  1. 1. Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  4. 4. Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

Source: Middle East Journal of Rehabilitation and Health Studies Published:2025


Abstract

Background: Spasticity is a disabling condition commonly experienced by patients with multiple sclerosis (MS), significantly impacting their quality of life. Botulinum toxin (BT) has emerged as a potential therapeutic agent due to its ability to inhibit presynaptic acetylcholine release; however, its efficacy in MS patients remains inconsistent across the literature. Objectives: This systematic review and meta-analysis aimed to evaluate the overall efficacy of BT in reducing spasticity in MS patients, focusing on outcomes such as the Expanded Disability Status Scale (EDSS) and the Modified Ashworth Scale (MAS). The goal was to consolidate the available evidence to provide clearer clinical guidance. Methods: A systematic search of databases including Medline, Scopus, Embase, and Web of Science was conducted from January 2000 to April 2023. Additionally, references to the included studies were examined to ensure a comprehensive capture of relevant research. Data were extracted on total participants, publication date, country of origin, mean age, disease duration, EDSS scores, and key findings. Results: The initial search yielded 1,618 articles, of which 684 were duplicates. After applying exclusion criteria, 17 articles were selected for the systematic review, with 4 deemed suitable for meta-analysis. Participants' ages ranged from 38 to 53 years, with follow-up durations spanning 1 to 36 months. The most frequently reported complication following BT injection was muscle weakness. The standardized mean difference (SMD) for the MAS demonstrated significant effectiveness of BT at week 4 (SMD:-0.42; 95% CI:-0.77 to-0.6) and week 12 (SMD:-1.16; 95% CI:-1.77 to-0.54). Conclusions: Intramuscular injection of BT appears to be an effective treatment option for reducing spasticity in MS patients. However, further well-designed studies are needed to validate these findings and optimize treatment protocols. © 2025, Emami Razavi et al.
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