The effects of different injection techniques of botulinum toxin a in post-stroke patients with plantar flexor spasticity

Turna, Isil Fazilet; Erhan, Belgin; Gunduz, Necibe Berrin; Turna, Önder

doi:10.1007/s13760-018-0969-x

Cited by 9 publications

(17 citation statements)

References 14 publications

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“…The experiment was randomized, double-blind and placebo-controlled, but the limitations of the AS calls into question the results that showed significant reductions in spasticity. In a recent study by Turna et al [ 100 ] the effects of different injection techniques of BTX-A were investigated for treating ankle plantar flexor spasticity. To compare those techniques the effects of the treatment were evaluated with subjective scores including the AS, Brunnstrom stages, and Barthel index score, which again limits the reliability of the results.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Modeling of Spasticity for Clinical Assessment, Treatment and Rehabilitation

Cha

Arami

2020

Sensors

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Spasticity, a common symptom in patients with upper motor neuron lesions, reduces the ability of a person to freely move their limbs by generating unwanted reflexes. Spasticity can interfere with rehabilitation programs and cause pain, muscle atrophy and musculoskeletal deformities. Despite its prevalence, it is not commonly understood. Widely used clinical scores are neither accurate nor reliable for spasticity assessment and follow up of treatments. Advancement of wearable sensors, signal processing and robotic platforms have enabled new developments and modeling approaches to better quantify spasticity. In this paper, we review quantitative modeling techniques that have been used for evaluating spasticity. These models generate objective measures to assess spasticity and use different approaches, such as purely mechanical modeling, musculoskeletal and neurological modeling, and threshold control-based modeling. We compare their advantages and limitations and discuss the recommendations for future studies. Finally, we discuss the focus on treatment and rehabilitation and the need for further investigation in those directions.

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Section: Discussionmentioning

confidence: 99%

Quantitative Modeling of Spasticity for Clinical Assessment, Treatment and Rehabilitation

Cha

Arami

2020

Sensors

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“…Almost all HCPs used at least one guidance device and one in every three HCPs used all three devices (US, EMG and ES). Published data indicate improved accuracy of injection with instrumental guidance for SP and CD, compared with palpation only ( 21 – 23 ). For both SP and CD, goals were discussed at every consultation by around three quarters of HCPs.…”

Section: Discussionmentioning

confidence: 99%

Botulinum Neurotoxin-A Injection in Adult Cervical Dystonia and Spastic Paresis: Results From the INPUT (INjection Practice, Usage and Training) Survey

et al. 2020

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Botulinum toxin-A (BoNT-A) is an effective treatment for cervical dystonia (CD) and spastic paresis (SP), but it requires in-depth knowledge of anatomy and injection techniques. The Ixcellence Network ® is an educational programme to provide neurology, neuropaediatrics, and physical medicine and rehabilitation (PMR) specialists with access to best clinical practices and innovations regarding SP and CD management with BoNT-A. To assess the benefits of such educational programmes and identify unmet needs, a multidisciplinary scientific committee designed INPUT (INjection Practice, Usage & Training), an international multicentric survey describing training and practices among this trained and experienced population. A self-completed questionnaire was sent online to 553 trainees and 14 trainers from the Ixcellence Network ®. Among the 131 respondents, 92% specialized in PMR (48%) or neurology (44%), with a mean experience of 15.5 years in their clinical fields and 10.9 years of BoNT-A injection. Most of them (98%) reported having received training before performing their first BoNT-A injection and attending specific courses on how to perform it without any instrumental guidance (76%), and with ultrasound (73%), electrical stimulation (44%) or electromyography (41%). In terms of practices, 92% of respondents reported using at least one guidance technique while injecting, with ultrasound being the most used technique (48%). Attending specific courses was significantly associated with greater self-confidence and use, e.g. for injection with ultrasound, mean self-confidence, on a scale from 1 (not confident) to 10 (fully confident), was 7.9 for trained respondents (vs 4.0 for untrained respondents, p < 0.001) of whom 70% stated that they used this technique regularly or systematically (vs. 11% of untrained healthcare professionals (HCPs), p < 0.0001). Moreover, 84% of respondents reported having trained colleagues, residents or fellows through theoretical (70%) or practical teaching in individuals (80%) or in small groups (65%). Overall, 86% of respondents reported a notable increase over the past Chung et al. Results of the INPUT Survey 5 years of the number of patients treated with BoNT-A. INPUT is the first international survey describing training and practices in SP and CD management of physicians who attended a dedicated educational programme. The results highlighted the importance of training for self-confidence, and the use of specific techniques and new approaches.

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“…Additional application of ultrasound (USG) or electromyography (EMG) allows for precise definition of the injection site [4]. Both USG and ES are effective methods of BoNT-A injection [10]. The use of ultrasound for the BoNT-A supply, compared to the conventional method, enables a more precise administration of the agent, thus giving better clinical results [11,12].…”

Section: Use Of Ultrasound (Ultrasonography) and Electromyography (Emg) In The Supply Of Botulinum Toxinmentioning

confidence: 99%

Botulinum in selected neurological disorders - review

Rocka¹,

Piędel²,

Piwek³

et al. 2021

J Pre Clin Clin Res.

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Introduction and objective. Botulinum toxin (BoNT) has been used in medicine for many years. BoNT, prevents acetylcholine from being released into synapses, causing flaccid muscles paralysis. The article reviews the current knowledge of botulinum toxin application in the treatment of neurological diseases, focusing on therapeutic efficacy and side-effects. The aim of the review is to analyze the largest possible number of neurological conditions in which the application of botulinum toxin was considered. Materials and method. A literature review of the last 10 years was conducted using the key words: 'botulinum toxin neurology' in the PubMed database, with the search criteria: clinical trials, free full text in English, research on humans. 2,581 manuscripts were found. After initial analysis, 188 publications were selected for further elaboration. Finally, 61 compatible publications were identified and included in the review. Abbreviated description of the state of knowledge. In the treatment of Tourette's syndrome with BoNT, despite the reduction in tics frequency, patients did not report any benefits. There are promising reports on the reduction of the intensity of neuropathic pain and neuralgia in trigeminal neuralgia after the use of BoNT-A. Improvement in rest tremor has been seen in patients with Parkinson's disease. Administration of BoNT-A among patients with bruxism was associated with improved sleep quality and reduction of the symptoms intensity. Research confirms the effectiveness of using BoNT in the treatment of bothersome symptoms occurring in migraine, drooling, cervical dystonia and neurogenic bladder. Conclusions. Although the use of BoNT in neurological diseases is widely studied and used, the appropriate administration technique and safety of use are worth further research.

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The effects of different injection techniques of botulinum toxin a in post-stroke patients with plantar flexor spasticity

Cited by 9 publications

References 14 publications

Quantitative Modeling of Spasticity for Clinical Assessment, Treatment and Rehabilitation

Quantitative Modeling of Spasticity for Clinical Assessment, Treatment and Rehabilitation

Botulinum Neurotoxin-A Injection in Adult Cervical Dystonia and Spastic Paresis: Results From the INPUT (INjection Practice, Usage and Training) Survey

Botulinum in selected neurological disorders - review

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