Table 1 Characteristics of included studies
Severity of Spasticity | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Study | Total Included Cases | Mean Age (SD) | GMFCS level# or ambulatory status | male % | % of CP patients * | Average measurement time | Measurement Scale | Average Final dose (µg/day) | Dose Details | |||||||
I | II | III | IV | V | ||||||||||||
Barney et al., 2020 [66] | 28 | 9.9 (3.08) | 3.1% | 6.3% | 12.5% | 78.1% | 53% | 100% | 5.61 | Modified Ashworth Scale | ||||||
Simsek et al., 2018 [67] | 8 | 10.63 (2.33) | All non-ambulant | 88% | 100% | 12.88 | Modified Ashworth Scale | 81.38 | 50–140 µg/day | |||||||
Yoon et al., 2017 [68] | 8 | 36.28 | 57.9% non-ambulant | 74% | 100% | 12.00 | Modified Ashworth Scale | Bolus: 50 µg on the first day, 75 µg on the second day, 100 µg on the third day (if the second-day dose was ineffective) | ||||||||
Dekopov et al., 2015 [69] | 8 | 25.88 (9.06) | 60% | 100% | 14.00 | Ashworth Scale | 214.00 | 50–75 µg/day (the rate was daily increased by 15—20% of the total dose until a clinical effect was achieved) | ||||||||
Walter et al., 2014 [70] | 15 | 12 [4] | 23.1% | 76.9% | 33% | 87% | 42.00 | Modified Ashworth Scale | 439.00 | 25–820 µg/day | ||||||
Margetis et al., 2014 [71] | 8 | 30.38 (9.05) | 75% | 100% | 12.00 | Modified Ashworth Scale | 156.30 | 60–380 µg/24 h | ||||||||
Gray et al., 2012 [72] | 37 | 10.16 (3.25) | 48.6% | 51.4% | 51% | 100% | 18.00 | Modified Ashworth Scale | 250.00 | 50–650 µg/24 h (9 months), 35–1000 µg/24 h (18 months) | ||||||
Ramstad et al., 2010 [73] | 28 | 8.58 | 5.7% | 37.1% | 57.2% | 71% | 100% | 18.00 | Modified Ashworth Scale | 157.00 | range 86–576 µg ⁄ day | |||||
Tassëel Ponche et al., 2010 [26] | 25 | 29.6 (12.66) | All wheelchair-dependent: Third-party dependent 76%, Independent 24% | 56% | 100% | Modified Ashworth Scale | 292.00 | 25–1015 µg per day (292 ± 106.4 µg per day) | ||||||||
Brochard et al., 2009 [74] | 7 | 15 (5.4) | 42.9% | 57.1% | 29% | 100% | 16.00 | Ashworth Scale | 121.80 | range 75–250 µg ⁄ day | ||||||
Motta et al., 2008 [75] | 20 | 11.4 (3.57) | 10% | 40% | 35% | 15% | 75% | 100% | 12.00 | Ashworth Scale | ||||||
Awaad et al., 2003 [76] | 21 | 13.69 (7.43) | 69% | 100% | 18.00 | Ashworth Scale | 563.23 | 50-µg bolus, 75–1196 µg/day | ||||||||
Murphy et al., 2002 [77] | 23 | 8.8 (3.9) | 57.1% non- ambulant | 74% | 100% | 6.00 | Ashworth Scale | |||||||||
Meythaler et al., 2001 [78] | 13 | 25.46 (10.15) | 77% | 100% | 12.00 | Ashworth Scale | 263.00 | 160–470 µg/d | ||||||||
Gilmartin et al., 2000 [79] | 40 | 10.30 | 57% | 100% | 12.00 | Ashworth Scale | 265.20 | 50-µg bolus, 25 µg/day to 1350 µg/day | ||||||||
Avellino et al., 2000 [80] | 4 | 28.3 (5.3) | 75% | 100% | 12.00 | Ashworth Scale | 460.80 | 460.8 ± 345.6 µg/day | ||||||||
Wiens et al., 1998 [25] | 17 | 10.20 | 59% | 100% | 3.00 | Ashworth Scale | ||||||||||
Armstrong et al., 1997 [81] | 10 | 10.42 (4.45) | 12.00 | Ashworth Scale | 466.18 | |||||||||||
Creedon et al., 1997 [82] | 23 | 35.6 (11.7) | 100% | 19.60 | Ashworth Scale | 305.00 | ||||||||||
Motor Function section | ||||||||||||||||
Dekopov et al., 2015 [69] | 7 | 25.88 (9.06) | 60% | 100% | 14.00 | GMFM-88 | 214.00 | 50–75 µg/day (the rate was daily increased by 15—20% of the total dose until a clinical effect was achieved) | ||||||||
Gray et al., 2014 [83] | 23 | 10.83 (3.5) | 13.0% | 65.3% | 21.7% | 70% | 100% | 9.00 | GMFM-88 | 158.00 | 50 to 530 µg/day | |||||
Motta et al., 2011 [84] | 37 | 13.58 [7] | 24.3% | 35.2% | 18.9% | 21.6% | 49% | 100% | 12.00 | GMFM-88 | ||||||
Hoving et al., 2009 [85] | 12 | 13.7 (2.9) | 5.9% | 11.8% | 82.3% | 47% | 100% | 12.00 | GMFM-66 | 232.76 | 61–233 µg/day | |||||
Bleyenheuft et al., 2007 [86] | 7 | 18.4 [7] | 71.4% dependent on a wheelchair most of the day (spasticity preventing ambulation), 28.6% non-ambulant | 29% | 100% | 14.29 | GMFM-66 | 110.57 | external 45–150 µg/24 h, internal 66–160 µg/24 h | |||||||
Krach et al., 2005 [87] | 31 | 11.90 | Ambulatory without devices: 3.2%, ambulatory with orthoses or devices: 22.6%, mobility by crawling on hands and knees or independent wheelchair: 16.1%, non-ambulatory however having other purposeful motor activity: 35.5%, minimal or no purposeful motor activity: 22.6% | 61% | 100% | 12.00 | GMFM-88 | 242.00 | 73–242 µg/day | |||||||