{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:38:54Z","timestamp":1791545934878,"version":"4.3.4"},"reference-count":33,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,6,18]],"date-time":"2021-06-18T00:00:00Z","timestamp":1623974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Post-stroke spasticity impedes patients\u2019 rehabilitation progress. Contradictory evidence has been reported in using Botulinum Neurotoxin type A (BoNT-A) to manage post-stroke lower extremity spasticity (PLES); furthermore, an optimum dose of BoNT-A for PLES has not yet been established. Therefore, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to identify the efficacy and optimal dose of BoNT-A on PLES. \"Meta\" and \"Metafor\" packages in R were used to analyze the data. Hedges\u2019 g statistic and random effect model were used to calculate and pool effect sizes. Twelve RCTs met the eligibility criteria. Muscle tone significantly improved in week four, week eight, and maintained to week twelve after BoNT-A injection. Improvements in functional outcomes were found, some inconsistencies among included studies were noticed. Dosage analysis from eight studies using Botox\u00ae and three studies using Dysport\u00ae indicated that the optimum dose for the commonest pattern of PLES (spastic plantar flexors) is medium-dose (approximately 300U Botox\u00ae or 1000 U Dysport\u00ae). BoNT-A should be regarded as part of a rehabilitation program for PLES. Furthermore, an optimal rehabilitation program combined with BoNT-A management needs to be established. Further studies should also focus on functional improvement by BoNT-A management in the early stage of stroke.<\/jats:p>","DOI":"10.3390\/toxins13060428","type":"journal-article","created":{"date-parts":[[2021,6,20]],"date-time":"2021-06-20T21:50:15Z","timestamp":1624225815000},"page":"428","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Efficacy and Optimal Dose of Botulinum Toxin A in Post-Stroke Lower Extremity Spasticity: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5255-4505","authenticated-orcid":false,"given":"Thanh-Nhan","family":"Doan","sequence":"first","affiliation":[{"name":"Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan"},{"name":"Department of Rehabilitation, Quang Nam Northern Mountainous Region General Hospital, Quang Nam 560000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Ying","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3540-6225","authenticated-orcid":false,"given":"Li-Wei","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan"},{"name":"Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan"},{"name":"Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung 413505, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1212\/WNL.0b013e3182762448","article-title":"Toward an epidemiology of poststroke spasticity","volume":"80","author":"Wissel","year":"2013","journal-title":"Neurology"},{"key":"ref_2","first-page":"1","article-title":"The negative impact of spasticity on the health-related quality of life of stroke survivors: A longitudinal cohort study","volume":"13","author":"Gillard","year":"2015","journal-title":"Heal Qual. 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