Functional impact of different muscle localization techniques for Botulinum neurotoxin A injections in clinical routine management of post-stroke spasticity. (2nd January 2017)

• Record Type: Journal Article
• Authors: Zeuner, Kirsten E.; Knutzen, Arne; Kühl, Carina; Möller, Bettina; Hellriegel, Helge; Margraf, Nils G.; Deuschl, Günther; Stolze, Henning
• Is Part Of: Brain injury. Volume 31:Number 1(2017)
• Page Start: 75
• Page End: 82
• Publication Date: 2017-01-02
• Subjects: Botulinum neurotoxin -- arm spasticity -- stroke -- electromyography -- ultrasound; Brain damage -- Periodicals; Brain -- Wounds and injuries -- Periodicals; Brain Injuries -- Periodicals; 617.481
• DOI: 10.1080/02699052.2016.1218545
• Languages: English
• ISSNs: 0269-9052

Abstract

ABSTRACT: Background : Treatment options for spasticity include intramuscular botulinum neurotoxin A (BoNT-A) injections. Both ultrasound (US) or electromyographic (EMG) guided BoNT-A injections are employed to isolate muscles. To date, most studies have included patients naïve to BoNT-A or following a prolonged wash out phase. Objective : To determine the impact of US/EMG guided BoNT-A injections on function in outpatients with spasticity receiving an established re-injection regime. Methods : Thirty patients post-stroke were investigated in a single-blinded, randomized controlled trial using a cross-over design for the EMG and US and a parallel design for the control group. The Modified Ashworth (MAS), Disability Assessment (DAS), Quality of Life (EQ-5D), self-rating scale and Barthel Index were assessed pre- and post-BoNT-A injections of upper limb muscles by a to the injection technique blinded person. Results : MAS improved in arm, finger and upper limb 4 weeks after BoNT-A treatment. The improvement showed no significant differences between the three injection techniques. Barthel Index, DAS and EQ-5D remained unchanged in all groups. Conclusions : This pilot study questions the impact of the instrumental guided injection techniques on everyday functionality in a routine clinical setting with established re-injection intervals. Larger trials are warranted with patients who are under long-term treatment on a regular basis.