The clinical utility of botulinum toxin injections targeted at the motor endplate zone in cervical dystonia

Delnooz, Cathérine C.S.; Veugen, Lidwien C E; Pasman, J.W.; Lapatki, Bernd G.; Dijk, Hans van; Warrenburg, B.P.C. van de

doi:10.1111/ene.12517

Cited by 28 publications

(20 citation statements)

References 25 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The identification of motor endplate zones with high-density surface EMG may help decreasing the BoNT dose by keeping the effect unaltered ( 52 ).…”

Section: Resultsmentioning

confidence: 99%

Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin

et al. 2017

View full text Add to dashboard Cite

Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored.

show abstract

“…The identification of motor endplate zones with high-density surface EMG may help decreasing the BoNT dose by keeping the effect unaltered ( 52 ).…”

Section: Resultsmentioning

confidence: 99%

Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin

et al. 2017

View full text Add to dashboard Cite

show abstract

“…High density surface EMG can also define the endplate zone (Lapatki et al , 2011). If attention is paid to injecting at the endplate, the effect will be greater (Delnooz et al , 2014, Gracies et al , 2009). …”

mentioning

confidence: 99%

Explanation of timing of botulinum neurotoxin effects, onset and duration, and clinical ways of influencing them

Hallett

2015

Toxicon

View full text Add to dashboard Cite

While the steps in the action of botulinum neurotoxin (BoNT) are well known, the factors underlying the timing of these steps are not fully understood. After toxin is injected into a muscle, it resides in the extracellular space and must be taken up into the nerve terminals. More toxin will be taken up if near the endplate. Toxin is distributed mainly by convection and there is likely little diffusion. Toxin that is not taken up will go into the general circulation where it may have a slight systemic effect. The uptake is activity and temperature dependent. Encouraging the unwanted muscle contractions after injection should be helpful. Cooling will decrease the uptake. The times for washout from the extracellular space and uptake of the toxin are not well established, but are likely measured in minutes. Toxin in the general circulation has a long half time. The time from injection to weakness is determined by how long it takes to get sufficient damage of the SNARE proteins to interfere with synaptic release. Toxins are zinc dependent proteases, and supplemental zinc may produce a greater effect. There will be weakness as long as there is residual toxin in the nerve ending.

show abstract

“…Combining this knowledge with our measurements, upper and middle segments of SCM could be suggested as the most appropriate parts for botulinum toxin injections. In a study of Delnooz et al, [21] the exact location of the motor end plates of SCM was revealed and they achieved equivalent results in full dose with a half dose of botulinum toxin. When the results obtained in such studies are used together with the results obtained in our study, we think that safer and more effective botulinum toxin applications can be made.…”

Section: Standardization Of Sternocleidomastoid For Botulinum Toxin Amentioning

confidence: 99%

Standardization of sternocleidomastoid for botulinum toxin applications

Torun¹,

Kendir²,

Uz³

2017

Anatomy

View full text Add to dashboard Cite

Objectives: Botulinum toxin is frequently applied to the sternocleidomastoid muscle (SCM) for torticollis treatment. During this application, bulb of the jugular vein located under SCM makes the interventions unsafe. Also, injecting the botulinum toxin into the infrahyoid muscles which lie under SCM may cause hoarseness and swallowing disorders. The aim of this study was to describe the most reliable and appropriate botulinum toxin injection sites to the SCM to avoid injury to neighboring neurovascular structures and adjacent muscles. Methods:In ten male cadavers, SCM was evaluated in three equal segments (upper, middle and lower). Muscle width and thickness at the center of each segment were measured. In one male cadaver, colored latex was injected according to the results of the measurements. Results:The respective mean width of upper, medial and lower segments were 33.15 (23-41) mm, 36.45 (28-45) mm and, 39.35 (15-50) mm, respectively. The mean thickness of upper, medial and lower segments were 5.29 (3.87-7.68) mm, 5.89 (3.56-8.32) mm and 3.60 (0.69-7.75) mm, respectively. There was no significant difference between the right and left sides. The thickest part of the muscle was the middle part, and the lower part was the thinnest. When the colored latex injected cadaver was dissected, the center of the muscle was observed as colored, while the neighboring structures were avoided. The thickest and safest part of SCM for the botulinum toxin injections was the middle part. Conclusion:Knowing the thickness of SCM will make the botulinum toxin applications to this muscle safer and easier.

show abstract

The clinical utility of botulinum toxin injections targeted at the motor endplate zone in cervical dystonia

Cited by 28 publications

References 25 publications

Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin

Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin

Explanation of timing of botulinum neurotoxin effects, onset and duration, and clinical ways of influencing them

Standardization of sternocleidomastoid for botulinum toxin applications

Contact Info

Product

Resources

About