{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T02:03:33Z","timestamp":1789178613192,"version":"build-2803163510"},"reference-count":66,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ipsen"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Disabling limb spasticity can result from stroke, traumatic brain injury or other disorders causing upper motor neuron lesions such as multiple sclerosis. Clinical studies have shown that abobotulinumtoxinA (AboBoNT-A) therapy reduces upper and lower limb spasticity in adults. However, physicians may administer potentially inadequate doses, given the lack of consensus on adjusting dose according to muscle volume, the wide dose ranges in the summary of product characteristics or cited in the published literature, and\/or the high quantity of toxin available for injection. Against this background, a systematic literature review based on searches of MEDLINE and Embase (via Ovid SP) and three relevant conferences (2018 to 2020) was conducted in November 2020 to examine AboBoNT-A doses given to adults for upper or lower limb muscles affected by spasticity of any etiology in clinical and real-world evidence studies. From the 1781 unique records identified from the electronic databases and conference proceedings screened, 49 unique studies represented across 56 publications (53 full-text articles, 3 conference abstracts) were eligible for inclusion. Evidence from these studies suggested that AboBoNT-A dose given per muscle in clinical practice varies considerably, with only a slight trend toward a relationship between dose and muscle volume. Expert-based consensus is needed to inform recommendations for standardizing AboBoNT-A treatment initiation doses based on muscle volume.<\/jats:p>","DOI":"10.3390\/toxins14110734","type":"journal-article","created":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T11:53:51Z","timestamp":1666785231000},"page":"734","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["AbobotulinumtoxinA Doses in Upper and Lower Limb Spasticity: A Systematic Literature Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Alexis","family":"Schnitzler","sequence":"first","affiliation":[{"name":"PRM Department, GH St Louis Lariboisi\u00e8re F. Widal, Paris University, 75010 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8729-8222","authenticated-orcid":false,"given":"Cl\u00e9ment","family":"Dince","sequence":"additional","affiliation":[{"name":"Ipsen, 92100 Boulogne-Billancourt, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0265-9338","authenticated-orcid":false,"given":"Andreas","family":"Freitag","sequence":"additional","affiliation":[{"name":"Evidera, London W6 8BJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ike","family":"Iheanacho","sequence":"additional","affiliation":[{"name":"Evidera, London W6 8BJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Fahrbach","sequence":"additional","affiliation":[{"name":"Evidera, Waltham, MA 02451, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Lavoie","sequence":"additional","affiliation":[{"name":"Evidera, Montreal, QC H4T 1V6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Yves","family":"Loze","sequence":"additional","affiliation":[{"name":"Ipsen, 92100 Boulogne-Billancourt, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Forestier","sequence":"additional","affiliation":[{"name":"Ipsen, 92100 Boulogne-Billancourt, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1339-370X","authenticated-orcid":false,"given":"David","family":"Gasq","sequence":"additional","affiliation":[{"name":"Department of Functional Physiological Explorations, University Hospital of Toulouse, 31400 Toulouse, France"},{"name":"ToNIC, Toulouse NeuroImaging Center, Universit\u00e9 de Toulouse, Inserm, UPS, 31300 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e000195","DOI":"10.32892\/jmri.195","article-title":"Epidemiological Burden of Lower Limb Spasticity in Adults: A Systematic Review","volume":"4","author":"Javed","year":"2019","journal-title":"J. Med. Res. Innov."},{"key":"ref_2","first-page":"111","article-title":"Epidemiological, humanistic, and economic burden of illness of lower limb spasticity in adults: A systematic review","volume":"10","author":"Martin","year":"2014","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/PHM.0000000000000208","article-title":"Systematic literature review of abobotulinumtoxinA in clinical trials for adult upper limb spasticity","volume":"94","author":"Dashtipour","year":"2015","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e2468","DOI":"10.1097\/MD.0000000000002468","article-title":"Systematic Literature Review of AbobotulinumtoxinA in Clinical Trials for Lower Limb Spasticity","volume":"95","author":"Dashtipour","year":"2016","journal-title":"Medicine"},{"key":"ref_5","unstructured":"(2021, December 12). Agence nationale de s\u00e9curit\u00e9 du m\u00e9dicament et des produits de sant\u00e9 (ANSM)DYSPORT. Available online: http:\/\/agence-prd.ansm.sante.fr\/php\/ecodex\/frames.php?specid=60242321&typedoc=N&ref=N0255634.htm."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Field, M., Splevins, A., Picaut, P., van der Schans, M., Langenberg, J., Noort, D., Snyder, D., and Foster, K. (2018). AbobotulinumtoxinA (Dysport((R))), OnabotulinumtoxinA (Botox((R))), and IncobotulinumtoxinA (Xeomin((R))) Neurotoxin Content and Potential Implications for Duration of Response in Patients. Toxins, 10.","DOI":"10.3390\/toxins10120535"},{"key":"ref_7","unstructured":"Afssaps (French Health Products Safety Agency) (2021, December 12). Recommandations de Bonne Pratique. Traitements Medicamenteux de la SpasticiteRecommandations de Bonne Pratique. Traitements Medicamenteux de la Spasticite., Available online: https:\/\/archiveansm.integra.fr\/var\/ansm_site\/storage\/original\/application\/9771c86bf98d7af854c30b202846ab35.pdf."},{"key":"ref_8","unstructured":"Royal College of Physicians, British Society of Rehabilitation Medicine, The Chartered Society of Physiotherapy, Association of Chartered Physiotherapists in Neurology, and the Royal College of Occupational Therapists (2018). Spasticity in Adults: Man-Agement Using Botulinum Toxin. National Guidelines, RCP."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s00702-021-02312-4","article-title":"Consensus guidelines for botulinum toxin therapy: General algorithms and dosing tables for dystonia and spasticity","volume":"128","author":"Dressler","year":"2021","journal-title":"J. Neural. Transm."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e01069","DOI":"10.1002\/brb3.1069","article-title":"Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients","volume":"8","author":"Alvisi","year":"2018","journal-title":"Brain Behav."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1080\/09638280801906388","article-title":"Management of shoulder and proximal upper limb spasticity using botulinum toxin and concurrent therapy interventions: A preliminary analysis of goals and outcomes","volume":"31","author":"Ashford","year":"2009","journal-title":"Disabil. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2402","DOI":"10.1161\/01.STR.31.10.2402","article-title":"A randomized, double-blind, placebo-controlled, dose-ranging study to compare the efficacy and safety of three doses of botulinum toxin type A (Dysport) with placebo in upper limb spasticity after stroke","volume":"31","author":"Bakheit","year":"2000","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1046\/j.1468-1331.2001.00277.x","article-title":"A randomized, double-blind, placebo-controlled study of the efficacy and safety of botulinum toxin type A in upper limb spasticity in patients with stroke","volume":"8","author":"Bakheit","year":"2001","journal-title":"Eur. J. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1080\/09638280110112891","article-title":"The effects of botulinum toxin treatment on associated reactions of the upper limb on hemiplegic gait-A pilot study","volume":"24","author":"Bakheit","year":"2002","journal-title":"Disabil. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1136\/jnnp.2003.035139","article-title":"The beneficial antispasticity effect of botulinum toxin type A is maintained after repeated treatment cycles","volume":"75","author":"Bakheit","year":"2004","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2402","DOI":"10.1016\/j.apmr.2014.05.017","article-title":"Measuring spasticity and fine motor control (Pinch) change in the hand after botulinum toxin-a injection using dynamic computerized hand dynamometry","volume":"95","author":"Barden","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"870","DOI":"10.2340\/16501977-0251","article-title":"A single-blinded, randomized pilot study of botulinum toxin type a combined with non-pharmacological treatment for spastic foot","volume":"40","author":"Baricich","year":"2008","journal-title":"J. Rehabil. Med."},{"key":"ref_18","first-page":"519","article-title":"Walking assessment with instrumented insoles in patients with lower limb spasticity after botulinum toxin infiltration","volume":"27","author":"Beseler","year":"2012","journal-title":"Neurologia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1136\/jnnp.61.1.30","article-title":"Use of botulinum toxin in stroke patients with severe upper limb spasticity","volume":"61","author":"Bhakta","year":"1996","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1136\/jnnp.69.2.217","article-title":"Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: A randomised double blind placebo controlled trial","volume":"69","author":"Bhakta","year":"2000","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1136\/jnnp.61.3.265","article-title":"A randomised, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients","volume":"61","author":"Burbaud","year":"1996","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1590\/S0004-282X2007000400008","article-title":"Does botulinum toxin improve the function of the patient with spasticity after stroke?","volume":"65","author":"Cardoso","year":"2007","journal-title":"Arq. Neuro-Psiquiatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1080\/10749357.2017.1420009","article-title":"Analysis of a 15-years\u2019 experience in including shoulder muscles, when treating upper-limb spasticity post-stroke with botulinum toxin type A","volume":"25","author":"Carvalho","year":"2018","journal-title":"Top. Stroke Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"147","DOI":"10.2340\/16501977-1909","article-title":"Functional effects of botulinum toxin type-A treatment and subsequent stretching of spastic calf muscles: A study in patients with hereditary spastic paraplegia","volume":"47","author":"Weerdesteyn","year":"2015","journal-title":"J. Rehabil. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/00002826-199706000-00002","article-title":"Automatic EMG-guided botulinum toxin treatment of spasticity","volume":"20","author":"Finsterer","year":"1997","journal-title":"Clin. Neuropharmacol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1002\/mds.20395","article-title":"Nerve stimulation boosts botulinum toxin action in spasticity","volume":"20","author":"Frasson","year":"2005","journal-title":"Mov. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"55","DOI":"10.11604\/pamj.2020.35.55.16091","article-title":"Efficacy of botulinum toxin a for the treatment of hemiparesis in adults upper limb spasticity","volume":"35","author":"Ghroubi","year":"2020","journal-title":"Pan Afr. Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2245","DOI":"10.1212\/WNL.0000000000004687","article-title":"Efficacy and safety of abobotulinumtoxinA in spastic lower limb: Randomized trial and extension","volume":"89","author":"Gracies","year":"2017","journal-title":"Neurology"},{"key":"ref_29","first-page":"S365","article-title":"ISPR8-2514: Simultaneous upper and lower limb abobotulinumtoxina injections and guided self-rehabilitation contracts in spastic hemiparesis: Baseline data from the engage study","volume":"1","author":"Gracies","year":"2018","journal-title":"J. Int. Soc. Phys. Rehabil. Med."},{"key":"ref_30","first-page":"S255","article-title":"Poster 292 Improvement of Spasticity Following AbobotulinumtoxinA (Dysport R) Injections in Shoulder Muscles in Hemiparetic Patients with Upper Limb Spasticity-Sub-Analysis of a Prospective, Long-Term, Open-Label Study with Single and Repeated Injection Cycles","volume":"8","author":"Gul","year":"2016","journal-title":"PM R J. Inj. Funct. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1002\/mds.21809","article-title":"Botulinum neurotoxin type A injections reduce spasticity in mild to moderate hereditary spastic paraplegia-Report of 19 cases","volume":"23","author":"Hecht","year":"2008","journal-title":"Mov. Disord."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/0304-3940(94)12124-9","article-title":"Short-term electrical stimulation enhances the effectiveness of Botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients","volume":"201","author":"Hesse","year":"1995","journal-title":"Neurosci. Lett."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1191\/026921598668275996","article-title":"Botulinum toxin type A and short-term electrical stimulation in the treatment of upper limb flexor spasticity after stroke: A randomized, double-blind, placebo-controlled trial","volume":"12","author":"Hesse","year":"1998","journal-title":"Clin. Rehabil."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/WNF.0b013e318296e630","article-title":"Dysport (botulinum toxin type A) in routine therapeutic usage: A telephone needs assessment survey of european physicians to evaluate current awareness and adherence to product labeling changes","volume":"36","author":"Hubble","year":"2013","journal-title":"Clin. Neuropharmacol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1046\/j.1525-1594.2002.06948.x","article-title":"A pilot study to investigate the combined use of botulinum neurotoxin type a and functional electrical stimulation, with physiotherapy, in the treatment of spastic dropped foot in subacute stroke","volume":"26","author":"Johnson","year":"2002","journal-title":"Artif. Organs"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1177\/0269215506072082","article-title":"A randomized controlled study of botulinum toxin A in the treatment of hemiplegic shoulder pain associated with spasticity","volume":"21","author":"Kong","year":"2007","journal-title":"Clin. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.jamda.2012.03.005","article-title":"Can Botulinum Toxin Decrease Carer Burden in Long Term Care Residents With Upper Limb Spasticity? A Randomized Controlled Study","volume":"13","author":"Lam","year":"2012","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"jrm00068","DOI":"10.2340\/16501977-2695","article-title":"Abobotulinumtoxina injections in shoulder muscles to improve adult upper limb spasticity: Results from a phase 4 real-world study and a phase 3 open-label trial","volume":"52","author":"Lejeune","year":"2020","journal-title":"J. Rehabil. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"440","DOI":"10.2340\/16501977-0066","article-title":"Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial","volume":"39","author":"Marco","year":"2007","journal-title":"J. Rehabil. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"536","DOI":"10.2340\/16501977-0366","article-title":"Botulinum toxin a for treatment of upper limb spasticity following stroke: A multi-centre randomized placebo-controlled study of the effects on quality of life and other person-centred outcomes","volume":"41","author":"McCrory","year":"2009","journal-title":"J. Rehabil. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2781","DOI":"10.1007\/s10072-020-04392-8","article-title":"Botulinum toxin for the management of spasticity in multiple sclerosis: The Italian botulinum toxin network study","volume":"41","author":"Moccia","year":"2020","journal-title":"Neurol. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"864","DOI":"10.2340\/16501977-1853","article-title":"Goal attainment following upper-limb botulinum toxin-A injections: Are we facilitating achievement of client-centred goals?","volume":"46","author":"Nott","year":"2014","journal-title":"J. Rehabil. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.pmrj.2017.06.008","article-title":"Dose-Dependent Effects of AbobotulinumtoxinA (Dysport) on Spasticity and Active Movements in Adults With Upper Limb Spasticity: Secondary Analysis of a Phase 3 Study","volume":"10","author":"Brashear","year":"2018","journal-title":"PM R"},{"key":"ref_44","first-page":"199","article-title":"Botulinum toxin type-A in the management of spastic equinovarus deformity after stroke","volume":"19","author":"Otom","year":"2014","journal-title":"Neurosciences"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0022-510X(00)00439-1","article-title":"Botulinum toxin type-A treatment in spastic paraparesis: A neurophysiological study","volume":"181","author":"Pauri","year":"2000","journal-title":"J. Neurol. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1016\/j.apmr.2012.02.005","article-title":"Is spastic muscle echo intensity related to the response to botulinum toxin type A in patients with stroke? A cohort study","volume":"93","author":"Picelli","year":"2012","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1177\/0269215513497735","article-title":"Botulinum toxin injection into the forearm muscles for wrist and fingers spastic overactivity in adults with chronic stroke: A randomized controlled trial comparing three injection techniques","volume":"28","author":"Picelli","year":"2014","journal-title":"Clin. Rehabil."},{"key":"ref_48","first-page":"759","article-title":"Combined effects of robot-assisted gait training and botulinum toxin type A on spastic equinus foot in patients with chronic stroke: A pilot, single blind, randomized controlled trial","volume":"52","author":"Picelli","year":"2016","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"jrm00069","DOI":"10.2340\/16501977-2693","article-title":"Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A retrospective observational study","volume":"52","author":"Picelli","year":"2020","journal-title":"J. Rehabil. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e024340","DOI":"10.1136\/bmjopen-2018-024340","article-title":"Botulinum toxin treatment of spasticity targeted to muscle endplates: An international, randomised, evaluator-blinded study comparing two different botulinum toxin injection strategies for the treatment of upper limb spasticity","volume":"9","author":"Rekand","year":"2019","journal-title":"BMJ Open"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1177\/1545968311430824","article-title":"Botulinum toxin injection for hypertonicity of the upper extremity within 12 weeks after stroke: A randomized controlled trial","volume":"26","author":"Rosales","year":"2012","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta14260","article-title":"BoTULS: A multicentre randomized controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A","volume":"14","author":"Shaw","year":"2010","journal-title":"Health Technol. Assess."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1177\/1545968309341060","article-title":"Combined botulinum toxin type A with modified constraint-induced movement therapy for chronic stroke patients with upper extremity spasticity: A randomized controlled study","volume":"24","author":"Sun","year":"2010","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1080\/09638280400009360","article-title":"The lowest effective dose of botulinum A toxin in adult patients with upper limb spasticity","volume":"27","author":"Suputtitada","year":"2005","journal-title":"Disabil. Rehabil."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e002771","DOI":"10.1136\/bmjopen-2013-002771","article-title":"Results from the Upper Limb International Spasticity Study-II (ULIS-II): A large, international, prospective cohort study investigating practice and goal attainment following treatment with botulinum toxin a in real-life clinical management","volume":"3","author":"Fheodoroff","year":"2013","journal-title":"BMJ Open"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1159\/000073058","article-title":"Is the reduction of spasticity by botulinum toxin A beneficial for the recovery of motor function of arm and hand in stroke patients?","volume":"50","author":"Woldag","year":"2003","journal-title":"Eur. Neurol."},{"key":"ref_57","first-page":"47","article-title":"Comparing the efficacy of botulinum toxin with tizanidine in upper limb post stroke spasticity","volume":"12","author":"Yazdchi","year":"2013","journal-title":"Iran. J. Neurol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1136\/jnnp.2006.103341","article-title":"Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: A randomised, double blind, placebo controlled study of botulinum toxin A","volume":"78","author":"Yelnik","year":"2007","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.jbiomech.2006.11.011","article-title":"Upper limb muscle volumes in adult subjects","volume":"40","author":"Holzbaur","year":"2007","journal-title":"J. Biomech."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.jbiomech.2013.12.002","article-title":"Relationships of 35 lower limb muscles to height and body mass quantified using MRI","volume":"47","author":"Handsfield","year":"2014","journal-title":"J. Biomech."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"101579","DOI":"10.1016\/j.rehab.2021.101579","article-title":"Time course response after single injection of botulinum toxin to treat spasticity after stroke: Systematic review with pharmacodynamic model-based meta-analysis","volume":"65","author":"Ojardias","year":"2021","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_63","unstructured":"The Cochrane Collaboration (2021, May 19). Cochrane Handbook for Systematic Reviews of Interventions (June 2017: Handbook Editors\u2019 Update). Available online: http:\/\/handbook.cochrane.org\/."},{"key":"ref_64","first-page":"1","article-title":"The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers","volume":"34","author":"Hong","year":"2018","journal-title":"Educ. Inf."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.pmrj.2017.06.007","article-title":"Efficacy and Safety of AbobotulinumtoxinA (Dysport) for the Treatment of Hemiparesis in Adults With Upper Limb Spasticity Previously Treated With Botulinum Toxin: Subanalysis From a Phase 3 Randomized Controlled Trial","volume":"9","author":"Marciniak","year":"2017","journal-title":"PM R"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1002\/pmrj.12348","article-title":"Efficacy and Safety of AbobotulinumtoxinA for the Treatment of Hemiparesis in Adults with Lower Limb Spasticity Previously Treated With Other Botulinum Toxins: A Secondary Analysis of a Randomized Controlled Trial","volume":"12","author":"Esquenazi","year":"2020","journal-title":"PM R"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/11\/734\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:03:20Z","timestamp":1760144600000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/11\/734"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,26]]},"references-count":66,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["toxins14110734"],"URL":"https:\/\/doi.org\/10.3390\/toxins14110734","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,26]]}}}