A Moving Residual Limb: Botulinum Toxin to the Rescue

Abstract

<jats:title>Abstract</jats:title><jats:p>Movement disorders post-amputation are a rare complication and can manifest as the jumping stump phenomenon, a form of peripheral myoclonus. The pathophysiology remains unknown and there is currently no standardized treatment. We describe the case of a 57-year-old male with unremitting stump myoclonus, starting one month after transtibial amputation, in his residual limb without associated phantom or neurological pain. The consequence of the myoclonus was a reduction in prosthetic wearing time. Failure to respond to oral medication led us to attempt the use of botulinum neurotoxin Type A injections in the involved muscles of the residual limb. Injection trials, over a two-year period, resulted in an improvement of movement disorder, an increased prosthetic wearing time and a higher satisfaction level of the patient. Injection of botulinum toxin type A should be considered as an alternative treatment for stump myoclonus to improve prosthetic wearing time and comfort.</jats:p>

Jumping stump phenomenon: a case report

“…9,11 A neuroma can be an ectopic trigger zone, with increasing rate of contractions when local stimulation is applied. 1,9,10,12 However, in our case and in the case presented in the study conducted by Briand et al, 13 the neuroma showed no triggerable electric point, so local treatment was not indicated. Technical upper motor neuron workup in other cases, including brain and spine imaging, sensoryevoked potential, and electroencephalogram, were normal, except for one case with a lacunar infarct in the left anterolateral thalamus, known to be associated with dystonia and tremor.…”

“…14 Electromyography showed (a) rhythmic spontaneous short bursts of several motor unit potentials, myokymic discharges, or was normal. 1,5,7,9,11,13 One case showed a circadian rhythm (symptoms being worse at night) with a highly elevated index for periodic limb movements with reduced sleep efficiency on polysomnography, which is why pramipexole was suggested. 8 Drug treatment seems generally ineffective, as shown in our case.…”

“…8 Drug treatment seems generally ineffective, as shown in our case. 1,3,5,7,8,[10][11][12][13][14] Botulinum toxin treatment seems to have promising results, however, only temporarily. 1,6,7,9,13,14 Except for the, presumably psychiatric, case in 1852 described by Hancock, we found no other cases with a need for an amputation at a higher level.…”

“…1,3,5,7,8,[10][11][12][13][14] Botulinum toxin treatment seems to have promising results, however, only temporarily. 1,6,7,9,13,14 Except for the, presumably psychiatric, case in 1852 described by Hancock, we found no other cases with a need for an amputation at a higher level. 2 In our opinion, a multiprofessional and interdisciplinary approach is recommended, including physiotherapy, pain management, psychological treatment modalities, and cognitive behavioral therapy.…”

<p>Botulinum Toxin Type A Possibly Affects Ca_v3.2 Calcium Channel Subunit in Rats with Spinal Cord Injury-Induced Muscle Spasticity</p>

“…17,18 BoT-A is intended for intramuscular, intradetrusor and intradermal use, and has been increasingly used in clinical care for many neural disorders that include spasticity, 19 and other abnormal movement diseases. 20 Therefore, BoT-A is supposed to treat SCI-induced muscle spasticity. The calcium level plays an important role in the spasticity risk 21 and modulates the activity of calcium channel.…”