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Ultrasound-guided botulinum toxin injections

https://doi.org/10.14412/2074-2711-2016-2-4-9

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Abstract

One of the key conditions for achieving the desirable result during botulinum toxin therapy for muscular dystonia, spasticity, and other diseases accompanied by spasm, pain, and autonomic dysfunction (dystonias, spasticity, etc.) is the proper administration of the agent into the muscles directly involved in the pathological process. The exact entry of botulinum toxin into the target muscles is essential for successful and safe treatment because its injection into a normal muscle may cause side effects. The most common errors are the incorrect depth and incorrect direction of a needle on insertion. Therefore, the exact injection of the agent particularly into the shallow and deep muscles is a difficult task even for an experienced specialist and requires the use of controlling methods.

The European Consensus on Botulinum Toxin Therapy points out that various injection techniques are needed for the better identification of necessary muscles. However, there are currently no reports on the clear advantage of any technique. In our country, injections using palpation and anatomical landmarks have been widely used in routine practice so far; electromyographic monitoring and electrostimulation have been less frequently applied. In recent years, the new method ultrasound-guided injection has continued to grow more popular. This effective, accessible, and easy-to-use method makes it possible to manage a real-time injection process and to ensure the exact entry of the agent into the muscle. This paper is dedicated to a comparative analysis of different injection methods and to a description of the ultrasound-guided technique and its advantages over others. 

About the Authors

S. E. Khatkova
State Research Center of the Russian Federation, A.I. Burnazyan Federal Medical Biophysical Center, Federal Biomedical Agency of Russia, Moscow; Treatment and Rehabilitation Center, Ministry of Health of Russia, Moscow;
Russian Federation

Department of Rehabilitation Medicine, Sports Medicine, Balneology, and Physiotherapy with Course of Nursing

Department of Neurology for Stroke Patients 

46, Zhivopisnaya St., Build. 21, Moscow 123182

3, Ivankovskoe Shosse, Moscow 125367



A. A. Balbert
Sverdlovsk Regional Clinical Psychoneurological Hospital for War Veterans, Sverdlovsk; Ural State Medical University, Ministry of Health of Russia, Yekaterinburg; Ural State University of Physical Culture, Chelyabinsk
Russian Federation

Department of Adaptive Exercise

25, Sobolev St., Yekaterinburg 620036

3, Repin St., Yekaterinburg 620028

1, Ordzhonikidze St., Chelyabinsk 454091 



References

1. Wissel J, Ward AB, Erztgaard P, et al. European consensus table on the use of botulinum toxin type A in adult spasticity. J Rehabil Med. 2009 Jan;41(1):13-25. doi: 10.2340/16501977-0303.

2. Wissel J, Poewe W. EMG for identification of dystonic, tremulous and spastic muscles and techniques for guidance of injections. In: Moore AP, Naumann M, editors. Handbook of Botulinum Toxin Treatment. 2nd edition. Wiley&Sons Ltd; 2003. P. 76-100.

3. Walter U, Dressler D. Ultrasound-guided botulinum toxin injections in neurology: technique, indications and future perspectives. Expert Rev Neurother. 2014 Aug;14(8):923-36.

4. Бальберт АА, Мякотных ВС. Использова- ние компьютерной томографии для контро- ля точности введения ботулотоксина при лечении синдрома грушевидной мышцы. Невский радиологический форум 2015. 4–6 апреля 2014 г., Санкт-Петербург. Сборник научных работ. Санкт-Петербург: ЭЛБИ-СПб; 2015. С. 55-6. [Bal'bert AA, Myakotnykh VS. Ispol'zovanie komp'yuternoi tomografii dlya kontrolya tochnosti vvedeniya botulotoksina pri lechenii sindroma grushevidnoi myshtsy. Nevskii radiologicheskii forum 2015. 4–6 aprelya 2014 g., Sankt-Peterburg. Sbornik nauchnykh rabot [The use of computed tomography to control the accuracy of the introduction of botulinum toxin in the treatment of piriformis syndrome. Nevsky radiological forum 2015. April 4–6, 2014, Saint-Petersburg. Collection of scientific works]. Saint-Petersburg: ELBI-SPb; 2015. P. 55-6.]

5. Picelli A,Tamburin S, Bonetti P, et al. Botulinumtoxin type A injection into the gastrocnemius muscle for spastic equinus in adults with stroke: a randomized controlled trial comparing manual needle placement, electrical stimulation and ultrasonography-guided injection techniques. Am J Phys Med Rehabil. 2012 Nov; 91(11):57-64.

6. Berweck S, Feldkamp A, Francke A, et al. Sonography-guided injection of botulinum toxin a in children with cerebral palsy. Neuropediatrics. 2002 Aug;33(4):221-3.

7. Chin TY, NattrassGR, Selber P, Graham HK. Accuracy of intramuscular injection of botulinum toxin A in juvenile cerebral palsy: a comparison between manual needle placement and placement guided by electrical stimulation. J Pediatr Orthop. 2005 May-Jun;25(3):286-91.

8. Picelli A, Roncari L, Baldessarelli S, et al. Accuracy of botulinum toxin type A injection into the forearm muscles of chronic stroke patients with spastic flexed wrist and clenched fist: manual needle placement evaluated using ultrasonography. J Rehabil Med. 2014 Nov; 46(10):1042-5. doi: 10.2340/16501977-1871.

9. Henzel MK, Munin MC, Niyonkuru C, et al. Comparison of surface and ultrasound localization to identify forearm flexor muscles for botulinum toxin injections. PM R. 2010 Jul;2(7):642-6. doi: 10.1016/j.pmrj.2010.05.002.

10. Santamato A, Micello MF, Panza F, et al. Can botulinum toxin type A injection technique influence the clinical outcome of patients with post-stroke upper limb spasticity? A randomized controlled trial comparing manual needle placement and ultrasound-guided injection techniques. J Neurol Sci. 2014 Dec 15;347 (1-2):39-43. doi: 10.1016/j.jns.2014.09.016. Epub 2014 Sep 19.

11. Schroeder AS, Berweck S, Lee SH, Heinen F. Botulinum toxin treatment of children with cerebral palsy – a short review of different injection techniques. Neurotox Res. 2006 Apr;9(2-3):189-96.

12. Li Jiang, Zu-Lin Dou, Quing-Yuan Wang, et al. Evaluation of clinical outcomes of patients with post-stroke wrist and finger spasticity after ultrasonography-guided BTX-A injection and rehabilitation training. Front Hum Neurosci. 2015 Sep 2;9:485. doi: 10.3389/fnhum.2015. 00485. eCollection 2015.

13. Boon AJ, Oney-Marlow TM, Murthy NS, et al. Accuracy of electromyography needle placement in cadavers: non-guided vs. ultrasound guided. Muscle Nerve. 2011 Jul;44(1): 45-9. doi: 10.1002/mus.22008.


For citation:


Khatkova S.E., Balbert A.A. Ultrasound-guided botulinum toxin injections. Neurology, Neuropsychiatry, Psychosomatics. 2016;8(2):4-9. (In Russ.) https://doi.org/10.14412/2074-2711-2016-2-4-9

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)