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Ultrasound-guided botulinum toxin injections

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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 


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For citations:

Khatkova S.E., Balbert A.A. Ultrasound-guided botulinum toxin injections. Neurology, Neuropsychiatry, Psychosomatics. 2016;8(2):4-9. (In Russ.)

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