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Botulinum toxin reduces spasticity in adult stroke survivors but shows inconsistent benefits for gait and balanceBotulinum Toxin Reduces Spasticity in Adult Stroke Survivors

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Key Takeaway
Note that while botulinum toxin effectively reduces spasticity, its impact on gait and balance is inconsistent.

This meta-analysis evaluates the efficacy of botulinum toxin for treating spasticity and improving lower limb function in a population of 1740 adult stroke survivors. The analysis indicates that botulinum toxin is effective in reducing spasticity, which is the primary clinical goal for many patients with motor impairments following a stroke.

Regarding secondary outcomes, the authors note that benefits for gait and balance were limited and inconsistent across the included studies. This lack of consistency suggests that while the intervention addresses muscle tone, it may not reliably translate into improved mobility or stability in all patients.

The authors highlight significant limitations including considerable heterogeneity in intervention protocols, participant characteristics, dosing regimens, and the selection of target muscle groups. These factors contribute to the uncertainty regarding optimal treatment parameters.

Clinical application is currently limited by these inconsistencies. The authors recommend that future studies include specific subgroups and medium- to long-term follow-up to clarify efficacy across different patient profiles and to better optimize rehabilitation strategies for stroke survivors.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the functional outcomes of botulinum toxin beyond simple spasticity reduction. While it confirms the effectiveness of botulinum toxin for reducing spasticity, it does not provide evidence for improvements in gait or balance, which remain inconsistent. This finding complements other stroke management strategies such as non-immersive virtual reality for upper limb function and HF-rTMS for cognitive impairment, though it highlights the specific limitations of botulinum toxin regarding lower limb mobility.

A review of data from 1,740 adult stroke survivors looked at the effects of botulinum toxin. The study specifically focused on how this treatment affects spasticity, which is the stiff or tight muscles often caused by a stroke. It also looked at how the treatment might improve walking and balance.

The results showed that botulinum toxin was effective at reducing muscle spasticity. However, the findings for other goals were less clear. The study found that improvements in gait and balance were limited and inconsistent among the participants. This means the treatment does not always lead to better walking or stability for everyone.

Because there were many differences in how patients were treated, what doses they received, and which muscles were targeted, it is hard to say exactly how well it works for every individual. More research is needed to see how different types of patients respond over a longer period of time. Patients should talk to their doctors to discuss how these results apply to their specific recovery plan.

What this means for you:
Botulinum toxin helps reduce muscle stiffness after a stroke, but its effects on walking and balance are inconsistent.

Common questions

Does botulinum toxin help with muscle stiffness after a stroke?

Yes, the study of 1,740 adults found that botulinum toxin is effective in reducing spasticity. Spasticity is a common condition where muscles become stiff or tight following a stroke. While it helps with muscle tension, you should speak with your doctor to see if this treatment is right for your specific needs.

Can botulinum toxin improve walking and balance after a stroke?

The evidence for improved gait and balance is limited and inconsistent. While the treatment helps reduce muscle stiffness, it does not consistently improve how patients walk or maintain their balance. Because results vary, your medical team can help determine what to expect based on your personal goals.

Why are the results for walking and balance so inconsistent?

The study noted significant differences in treatment plans, including different dosing regimens and different muscle groups targeted. Because of these variations among the 1,740 participants, it is difficult to confirm a consistent benefit for gait and balance. More long-term research is needed to clarify how to best optimize rehabilitation.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
ObjectiveThis review aims to conduct a systematic review and meta-analysis on the effectiveness of botulinum toxin in the treatment of spasticity and the improvement of lower limb function in adult stroke survivors, based on randomized clinical trials.Data sourcesSearches were conducted across multiple databases, including Medline, Scopus, CINAHL, SPORTDiscus, Psychology and Behavioral Sciences Collection, and Cochrane, from inception until September 2025.Review MethodThis systematic review and meta-analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The meta-analysis was performed using Review Manager 5 software, with mean differences pooled using a random-effects model.ResultsThe analysis included 11 studies, with a total of 1740 adult participants. The results confirm that botulinum toxin is effective in reducing spasticity; however, the benefits on other outcomes, namely gait and balance, were limited and inconsistent. Considerable heterogeneity was also observed in intervention protocols, participant characteristics, dosing regimens, and the selection of target muscle groups.ConclusionIt is recommended that future studies prioritize the inclusion of subgroups and medium- and long-term follow-up. Only in this way will it be possible to clarify the true efficacy of botulinum toxin in different patient profiles and to contribute to the optimization of lower limb rehabilitation strategies after stroke.
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