ABSTRACT NUMBER: ESOC2026A440 SAFETY AND EFFICACY OF BOTULINUM TOXIN TYPE A FOR LOWER LIMB SPASTICITY IN POST-STROKE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract Background and aims Stroke is a leading cause of long-term disability worldwide, imposing a substantial burden on patients and healthcare systems. Lower limb spasticity is a frequent post-stroke complication that impairs gait, reduces mobility, increases fall risk, and limits independence, highlighting the need for effective therapeutic interventions. our aim is to systematically evaluate the safety and efficacy of Botulinum Toxin Type A (BoNT-A) in the management of lower limb spasticity among post-stroke patients. Methods This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for English-language randomized controlled trials comparing BoNT-A with placebo in post-stroke lower limb spasticity. Fourteen RCTs involving 1,431 patients were included. Data extraction and risk of bias assessment using the Cochrane ROB2 tool were independently performed by two reviewers. Meta-analyses were conducted using RevMan 5.3 with a random-effects model. Subgroup analyses were stratified by treatment duration (4, 8, and 12 weeks). Results BoNT-A significantly reduced muscle tone compared with placebo (MD −0.55, 95% CI −0.82 to −0.29; p<0.0001) and improved Modified Ashworth Scale scores (MD −0.51, 95% CI −0.78 to −0.24; p<0.0002) and Ashworth Scale scores (SMD −0.42, 95% CI −0.80 to −0.04; p=0.03). Greater improvements were observed with longer treatment durations. However, BoNT-A did not significantly improve functional outcomes, including six-minute walking distance, gait velocity, or Fugl–Meyer motor scores. Conclusions BoNT-A is a safe and effective treatment for reducing lower limb spasticity following stroke but demonstrates limited impact on functional mobility outcomes. Conflict of interest all authors have has nothing to disclose Figure 1 - belongs to Methods Figure 2 - belongs to Results