Anatomical locations of the motor endplates of sartorius muscle for botulinum toxin injections in treatment of muscle spasticity

Yi, Kyu‐Ho; Lee, Ji‐Hyun; Lee, Dongkeun Kenneth; Hu, Hyewon; Seo, Kyle K.; Kim, Hee‐Jin

doi:10.1007/s00276-021-02813-7

Cited by 27 publications

(19 citation statements)

References 50 publications

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“…According to the results of this experiment, the INDR of the gastrocnemius muscle is located in the upper part of the muscle belly instead of the middle part, thus suggesting that the efficacy of BTX-A injections into the middle of the muscle belly is unsatisfactory. The reason for this is the motor endplate band (at the exact location of INDR) is located in the middle of the muscle belly only when the muscle is composed of muscle fibers of equal length, and the position of the motor endplate band varies in muscles with different morphological properties (27)(28)(29). The changes in gait, Zea Longa scores, muscle tone, and MRI scans of the rats before and after model creation indicated success in creating the rat model of muscle spasticity secondary to cerebral stroke for this experiment.…”

Section: Discussionmentioning

confidence: 99%

The highest region of muscle spindle abundance should be the optimal target of botulinum toxin A injection to block muscle spasms in rats

Li²,

Yang³

et al. 2023

Front. Neurol.

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PurposeThe effective relief of muscle spasticity requires prompt solutions in rehabilitation medicine. This study aimed to reveal that the highest region of muscle spindle abundance is the optimal target of botulinum toxin A (BTX-A) injections for relieve muscle spasm.MethodsSixty adult, male Sprague–Dawley rats with lower limbs spasm caused by stroke after modeling, weighing (200 ± 20) g, were included in this study. The modelrats were divided into four groups: muscle spasm model group (group A), model rats treated with BTX-A injections into the middle of the muscle belly (group B), model rats treated with BTX-A injections into the center of the intramuscular nerve-dense region (INDR) (group C), and model rats treated with BTX-A injection into the center of the highest region of muscle spindle abundance (HRMSA) (group D). Groups B, C, and D were further divided into two subgroups: the 3rd and 6th days after BTX-A injection. The rats in each group were assigned modified Ashworth scale scores (MAS), and the changes in gastrocnemius muscle tone, wet muscle weight, and cross-sectional area of muscle fiber were detected.ResultsMuscle spindle abundance was the highest in the upper part of the INDR. Group B experienced no significant changes in MAS, muscle tone, wet muscle weight, or cross-sectional area of the muscle fiber. Conversely, groups C and D experienced a decrease in these indicators. Group C experienced the most significant decrease in wet muscle weight and cross-sectional area of muscle fibers. Group D experienced the most notable decrease in MAS and muscle tone. There were no significant differences in the indicators between the 3rd and 6th days after BTX-A injections in group B and there were significant differences in the improvement in the indicators between the two subgroups in groups C and D, with group D experiencing more notable intersubgroup differences.ConclusionThe efficacy of BTX-A injections into the HRMSA is significantly superior to that of conventional BTX-A injections into the middle of the belly muscle or the INDR in the treatment of muscle spasms. Hence, HRMSA should be the optimal target of BTX-A to relieve muscle spasms.

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Section: Discussionmentioning

confidence: 99%

The highest region of muscle spindle abundance should be the optimal target of botulinum toxin A injection to block muscle spasms in rats

Li²,

Yang³

et al. 2023

Front. Neurol.

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“…Although sensitivity to BoNT differs among individuals, there is no effective treatment for ptosis, which persists for several months [ 31 , 32 ]. Accurate BoNT injection points from an anatomical point of view have been suggested in various studies concerning BoNT injection in specific muscles [ 16 , 17 , 18 , 19 , 20 , 21 , 33 , 34 , 35 , 36 , 37 ]. According to the meta-analysis conducted by Camargo et al, most studies had duration of treatment of 5 months [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies on BoNT injection points in muscles have previously been published on external anatomical standards ( Figure 2 ) [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. We searched for articles using the following keywords: “botulinum neurotoxin in nose region” and “side effect of botulinum neurotoxin injection in nose wrinkle” on Pubmed and Scopus.…”

Section: Introductionmentioning

confidence: 99%

Novel Anatomical Guidelines on Botulinum Neurotoxin Injection for Wrinkles in the Nose Region

Lee

et al. 2022

Toxins

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Botulinum neurotoxin injection surrounding the nose area is frequently used in aesthetic settings. However, there is a shortage of thorough anatomical understanding that makes it difficult to treat wrinkles in the nose area. In this study, the anatomical aspects concerning the injection of botulinum neurotoxin into the nasalis, procerus, and levator labii superioris alaeque muscles are assessed. In addition, the present knowledge on localizing the botulinum neurotoxin injection point from a newer anatomy study is assessed. It was observed that, for the line-associated muscles in the nose region, the injection point may be more precisely defined. The optimal injection sites are the nasalis, procerus, and levator labii superioris alaeque muscles, and the injection technique is advised. We advise the best possible injection sites in association with anatomical standards for commonly injected muscles to increase efficiency in the nose region by removing the wrinkles. Similarly, these suggestions support a more precise procedure.

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“…Accurate targeting of spastic muscles is fundamental. A precise anatomical localization maximizes the amount of BoNT administered within the target structure, at the same time minimizing unintended weakness of adjacent muscles due to toxin spread [14,15]. Admittedly, injections into deeply located or small muscle groups represent a more precarious context for non-targeted BoNT administration [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity

Asimakidou

Sidiropoulos

2023

Toxins

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Accurate targeting of overactive muscles is fundamental for successful botulinum neurotoxin (BoNT) injections in the treatment of spasticity. The necessity of instrumented guidance and the superiority of one or more guidance techniques are ambiguous. Here, we sought to investigate if guided BoNT injections lead to a better clinical outcome in adults with limb spasticity compared to non-guided injections. We also aimed to elucidate the hierarchy of common guidance techniques including electromyography, electrostimulation, manual needle placement and ultrasound. To this end, we conducted a Bayesian network meta-analysis and systematic review with 245 patients using the MetaInsight software, R and the Cochrane Review Manager. Our study provided, for the first time, quantitative evidence supporting the superiority of guided BoNT injections over the non-guided ones. The hierarchy comprised ultrasound on the first level, electrostimulation on the second, electromyography on the third and manual needle placement on the last level. The difference between ultrasound and electrostimulation was minor and, thus, appropriate contextualization is essential for decision making. Taken together, guided BoNT injections based on ultrasound and electrostimulation performed by experienced practitioners lead to a better clinical outcome within the first month post-injection in adults with limb spasticity. In the present study, ultrasound performed slightly better, but large-scale trials should shed more light on which modality is superior.

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Anatomical locations of the motor endplates of sartorius muscle for botulinum toxin injections in treatment of muscle spasticity

Cited by 27 publications

References 50 publications

The highest region of muscle spindle abundance should be the optimal target of botulinum toxin A injection to block muscle spasms in rats

The highest region of muscle spindle abundance should be the optimal target of botulinum toxin A injection to block muscle spasms in rats

Novel Anatomical Guidelines on Botulinum Neurotoxin Injection for Wrinkles in the Nose Region

A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity

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