Detection of Botulinum Toxin Muscle Effect in Humans Using Magnetic Resonance Imaging: A Qualitative Case Series

O’Dell, Michael W.; Villanueva, Mark; Creelman, Carly; Telhan, Gaurav; Nestor, Jaclyn; Hentel, Keith; Ballon, Douglas; Dyke, Jonathan P.

doi:10.1016/j.pmrj.2017.04.014

Cited by 7 publications

(6 citation statements)

References 67 publications

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“…In our study, the bolus had already dispersed by the time of the MRI exam at 6w after the BTX injections. Our results are in line with O'Dell et al (24). In their study, 200 units of BTX were injected in various leg muscles of adult patients who suffered a stroke (total dose of 200 units).…”

Section: Discussionsupporting

confidence: 92%

“…However, the trends in the time courses after treatment were compelling and in line with the existing literature (e.g., simulations, biopsy data, and animal studies). The hyperintensity on T 2 w images and T 2 maps up to 12 weeks after BTX treatment was clearly visible and confirmed the findings of the two published pilot studies in adults (24,25). We performed this pilot study in children over 8 years of age since they could follow instructions in the scanner and lie still without sedation.…”

Section: Discussionsupporting

confidence: 87%

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Quantification and Monitoring of the Effect of Botulinum Toxin A on Paretic Calf Muscles of Children With Cerebral Palsy With MRI: A Preliminary Study

et al. 2021

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Background: Muscles from patients with cerebral palsy (CP) are often spastic and form contractures that limit the range of motion. Injections of botulinum toxin A (BTX) into the calf muscles are an important treatment for functional equinus; however, improvement in gait function is not always achieved. BTX is also used to test muscle weakening for risk evaluation of muscle lengthening surgery. Our aim was to assess the effect of BTX over time on calf muscle properties in pediatric CP patients with MRI.Material and Methods: Six toe-walking CP patients (mean age 11.6 years) with indication for lengthening surgery were prospectively enrolled and received BTX injections into the gastrocnemius and soleus muscles. MRI scans at 3T of the lower legs and clinical examinations were performed pre-BTX, 6 weeks (6w), and 12 weeks (12w) post-BTX. A fat-suppressed 2D multi-spin-echo sequence was used to acquire T2 maps and for segmentation. Fat fraction maps were calculated from 3D multi-echo Dixon images. Diffusion tensor imaging (DTI) with a 2D echo-planar imaging (EPI) sequence yielded maps of the mean apparent diffusion coefficient (ADC) and of the fractional anisotropy (FA). Hyperintense regions of interest (ROIs) on the T2-weighted (T2w) images at 6w were segmented in treated muscles. Mean values of T2, fat fraction, ADC, and FA were calculated in hyperintense ROIs and in reference ROIs in non-treated muscles.Results: Hyperintensity on T2w scans and increased T2 (group mean ± standard deviation: 35 ± 1 ms pre-BTX, 45 ± 2 ms at 6w, and 44 ± 2 ms at 12w) were observed in all patients at the injection sites. The T2 increase was spatially limited to parts of the injected muscles. FA increased (0.30 ± 0.03 pre-BTX, 0.34 ± 0.02 at 6w, and 0.36 ± 0.03 at 12w) while ADC did not change in hyperintense ROIs, indicating a BTX-induced increase in extracellular space and a simultaneous decrease of muscle fiber diameter. Fat fraction showed a trend for increase at 12w. Mean values in reference ROIs remained unchanged.Conclusion: MRI showed limited spatial distribution of the BTX-induced effects in pediatric CP patients. It could be a promising non-invasive tool for future studies to test BTX treatment protocols.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 87%

Quantification and Monitoring of the Effect of Botulinum Toxin A on Paretic Calf Muscles of Children With Cerebral Palsy With MRI: A Preliminary Study

et al. 2021

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“…Observation period was rather short in patient 4, and patient 9 showed loss of strength 8 weeks after injection which was regained after BNT effect subsided. All other patients had more or less stable strength levels whereas three patients (2,7,10) showed increasing levels of at least ca. 1/3 compared to baseline measurement over the course of the observation period.…”

Section: Discussionmentioning

confidence: 94%

“…The intramuscular distribution of the toxin is dependent on the prevalent muscle architecture depicting different distribution patterns in spastic and healthy muscles when monitored by MRI (1). Previous results with heterogeneous observation periods indicated neurogenic denervation to occur earliest 3 months after BNT injection and persist until 12 months after baseline MRI (2,3). BNTMD was not detectable by MRI 2 and 6 months after injection in a study that focused on muscle atrophy (4).…”

Section: Introductionmentioning

confidence: 96%

Denervation Dynamics After Intramuscular BNT Injection in Patients With Focal Spasticity Monitored by MRI and Dynamometry–a Blinded Randomized Controlled Pilot Study

et al. 2021

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Introduction: Botulinumtoxin associated muscle denervation (BNTMD) can be detected by magnet resonance imaging (MRI), MRI may provide further insights into the exact timeline of BNTMD and the potential impact and timing of physical exercise. We aimed to assess the time interval until detection of BNTMD by MRI and whether immediate physical exercise after intramuscular BNT injection has a measurable effect on clinical parameters and the intramuscular denervation dynamics illustrated by MRI.Materials and Methods: Eleven age-matched patients were randomized to an “exercise” or “no-exercise” group. Eighty mouse-units of incobotulinumtoxin were injected into the spastic biceps muscle. MRI of the injected region, hand-held dynamometry of elbow flexor strength and clinical rating scales (mAS, CGI-I) were conducted in predefined intervals.Results: We could not detect BNTMD within 24 h but 7 days after injection independent of group allocation (exercise n = 6, no-exercise n = 5). Denervation signs were more diffuse and spread into adjacent muscles in patients having received exercise. We could not detect differences concerning clinical measures between the two groups.Conclusions: Physical exercise might influence BNTMD dynamics and promote propagation of T2-MR muscle denervation signs from the injected site into adjacent muscles.Trial registration:clinicaltrialsregister.eu, Identifier 2017-003117-25.

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“…The detection of botulinum toxin muscle effect in humans using magnetic resonance imaging, a qualitative case series carried out by O' Dell et al, 2017 [13] concluded that the use of magnetic resonance imaging to detect the volume of botulinum toxin muscle effect is feasible and may assist researchers in modeling the spread and diffusion of botulinum toxin within the human muscle.…”

Section: Introductionmentioning

confidence: 99%

Clinical Applications of Botulinum Toxin in Oral and Maxillofacial Surgery

Alahmary

Alqhtani

Alshahrani

et al. 2020

Open Access Maced J Med Sci

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Botulinum toxin is a toxin produced by Clostridium botulinum bacteria. This toxin has eight known serotypes, among which both A and B are currently used in medicine. Its mechanism of action acts on inhibiting acetylcholine release at neuromuscular junctions following its local injection. This toxin has wide applications in dentistry in general and in oral and maxillofacial (OMF) surgery in particular. It can be applied in the management of temporomandibular joint disorders, neuropathic facial pain, facial nerve palsy, hypertrophy, and hyperactivity of masticatory muscles as examples. At present, it can be used in cosmetic treatment in the facial region to control wrinkles and asymmetry. The therapeutic effects of these toxins are temporary and relatively safe if used in an appropriate manner. This review was aimed to identify the uses of botulinum toxin in surgical and non-surgical treatment of OMF problems, the types of treatment available, and benefits of those treatments.

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Detection of Botulinum Toxin Muscle Effect in Humans Using Magnetic Resonance Imaging: A Qualitative Case Series

Abstract: IV.

Cited by 7 publications

References 67 publications

Quantification and Monitoring of the Effect of Botulinum Toxin A on Paretic Calf Muscles of Children With Cerebral Palsy With MRI: A Preliminary Study

Quantification and Monitoring of the Effect of Botulinum Toxin A on Paretic Calf Muscles of Children With Cerebral Palsy With MRI: A Preliminary Study

Denervation Dynamics After Intramuscular BNT Injection in Patients With Focal Spasticity Monitored by MRI and Dynamometry–a Blinded Randomized Controlled Pilot Study

Clinical Applications of Botulinum Toxin in Oral and Maxillofacial Surgery

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