OnabotulinumtoxinA muscle injection patterns in adult spasticity: a systematic literature review

Abstract

BackgroundOnabotulinumtoxinA has demonstrated significant benefit in adult focal spasticity. This study reviews the injection patterns (i.e., muscle distribution, dosing) of onabotulinumtoxinA for treatment of adult spasticity, as reported in published studies.MethodsA systematic review of clinical trials and observational studies published between 1990 and 2011 reporting data on muscles injected with onabotulinumtoxinA in adult patients treated for any cause of spasticity.Results28 randomized, 5 nonrandomized, and 37 single-arm studies evaluating 2,163 adult patients were included. The most frequently injected upper-limb muscles were flexor carpi radialis (64.0% of patients), flexor carpi ulnaris (59.1%), flexor digitorum superficialis (57.2%), flexor digitorum profundus (52.5%), and biceps brachii (38.8%). The most frequently injected lower-limb muscles were the gastrocnemius (66.1% of patients), soleus (54.7%), and tibialis posterior (50.5%). The overall dose range reported was 5–200 U for upper-limb muscles and 10–400 U for lower-limb muscles.ConclusionsThe reviewed evidence indicates that the muscles most frequently injected with onabotulinumtoxinA in adults with spasticity were the wrist, elbow, and finger flexors and the ankle plantar flexors. OnabotulinumtoxinA was injected over a broad range of doses per muscle among the studies included in this review, but individual practitioners should be mindful of local regulatory approvals and regulations.

Approach for needle insertion into the tibialis posterior: An ultrasonography study

“…The tibialis posterior (TP) muscle is an important foot invertor and plantarflexor, and it is a muscle injected frequently with botulinum toxin to control lower limb spasticity. [1][2][3] Needle insertion into the TP is also performed frequently by electromyographers to study various neuromuscular diseases of the lower extremities, including radiculopathy and polyneuropathy. [4][5][6] Needle insertion into the TP has usually been performed by either a posterior or an anterior approach using anatomic landmarks, with or without electrical stimulation.…”

Comparing Electrical Stimulation With and Without Ultrasound Guidance for Phenol Neurolysis to the Musculocutaneous Nerve

“…There was no difference in botulinum toxin dosing to the elbow flexors related to method of guidance. However, no matter what the method of guidance, the total dose to the elbow flexors was relatively low compared to those in other studies in which onabotulinumtoxinA was used for the treatment of elbow flexor spasticity [15][16][17]. This dose included toxin to the brachioradialis, which is not innervated by the MCN and thus would not be treated by phenol neurolysis.…”

Effect of Onabotulinum Toxin A on Substance P and Receptor Neurokinin 1 in the Rat Ventral Prostate

“…When the target tissue is muscle, this chemical denervation results in paresis and organ involution. BoNTA causes an extended neuroparalysis that lasts for months in humans [19]. Because prostate function is under the influence of acetylcholine as well as norepinephrine and testosterone, additional mechanisms are likely involved in BoNTA effects on the prostate [10,20].…”