Assessing the neurophysiological effects of botulinum toxin treatment for adults with focal limb spasticity: a systematic review
Bibliographic record
Abstract
UNLABELLED: To examine effectiveness of botulinum toxin therapy (BoNT), accurate quantification of the neurological component of underlying spasticity is needed. PURPOSE: Systematically identify and summarize literature on neurophysiological methods to test the effectiveness of BoNT, discuss methodological aspects, and recommend best techniques for clinical and research settings. METHODS: Electronic databases were searched using specific keywords. Reviews and reference lists were hand-checked to find relevant studies. Studies in adults with focal limb spasticity were included. RESULTS: Over 300 articles were scanned for relevance, and a list of 90 relevant articles was made. After excluding reviews and studies in healthy controls or non-spasticity related BoNT, 22 articles were reviewed. Neurophysiological techniques included electromyography (EMG; n = 11), electrical nerve stimulation (n = 13), transcranial magnetic stimulation (TMS; n = 1), functional magnetic resonance imaging (fMRI; n = 1), reflex threshold (n = 4), Achilles tendon reflex (n = 1), reflex latency (n = 1). DISCUSSION: Maximum M-wave amplitude (M-max) and stretch reflex threshold techniques were successfully used to measure the neurophysiological effects of BoNT and have high test-retest reliability. EMG techniques require effective magnitude normalization techniques and establishing test-retest reliability. CONCLUSION: Serial electrical nerve stimulation can be incorporated into clinical practice to assist in follow-up. We recommend using M-max and stretch reflex threshold techniques to assess the neurophysiological effects.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".