Botulinum Neurotoxin A Injections Influence Stretching of the Gastrocnemius Muscle-Tendon Unit in an Animal Model

Haubruck, Patrick; Mannava, Sandeep; Plate, Johannes F.; Callahan, Michael F.; Wiggins, Walter F.; Schmidmaier, Gerhard; Tuohy, Christopher J.; Saul, Katherine R.; Smith, Thomas L.

doi:10.3390/toxins4080605

Cited by 9 publications

(5 citation statements)

References 31 publications

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“…It should be noted that the clinical finding that BTX‐A causes decreased passive resistance to stretch is mainly ascribable to decreased hypertonicity of the spastic muscle, that is, reduced spasticity . Even in non‐spastic mouse muscle, large doses of BTX‐A were shown to cause reduced tone and disrupted stretch reflexes, leading to decreased passive resistance during stretching . Our experiments were also conducted on normal muscles, but the measurements did not include passive stretching with movement, as used in the evaluation of spasticity, and no reflex loop was operational.…”

Section: Discussionmentioning

confidence: 99%

“…83 Even in non-spastic mouse muscle, large doses of BTX-A were shown to cause reduced tone and disrupted stretch reflexes, leading to decreased passive resistance during stretching. 84 Our experiments were also conducted on normal muscles, but the measurements did not include passive stretching with movement, as used in the evaluation of spasticity, and no reflex loop was operational. Therefore, modulation of muscle tone was not a part of our findings, and the increase in muscle passive force reflects enhanced muscular tissue stiffness.…”

Section: Discussionmentioning

confidence: 99%

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Effects of botulinum toxin type A on non‐injected bi‐articular muscle include a narrower length range of force exertion and increased passive force

Ateş

Yücesoy

2014

Muscle and Nerve

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of botulinum toxin type A on non‐injected bi‐articular muscle include a narrower length range of force exertion and increased passive force

Ateş

Yücesoy

2014

Muscle and Nerve

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“…The direct effect of intramuscular BoNT-A injection allows for the interruption of the hyperactive stretch reflex and modulation of passive muscle properties. Complementing this with kinesiotherapy may enable a better spread of the drug in the injected muscles and a consequently improved uptake of BoNT-A at the motor plates [29,30].…”

Section: Discussionmentioning

confidence: 99%

Shoulder Spasticity Treatment With Botulinum Toxin: A Nationwide Cross-Sectional Survey of Clinical Practices

Pinho,

Camões-Barbosa,

Hatia

et al. 2023

Cureus

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Introduction: Upper limb spasticity can be responsible for several complications (e.g., pain, spasms, contractures, deformity, decreased or lost motor control), which can have a negative impact on functional independence and the quality of life of patients. Chemodenervation with botulinum toxin type A (BoNT-A) is a first-line treatment of focal spasticity in the upper limb (UL). However, shoulder muscles were not included in the classical pivotal BoNT-A studies, leaving a knowledge gap regarding the application of intramuscular BoNT-A in the spasticity management of this anatomical area compared with the arm and forearm.Materials and methods: We conducted a descriptive cross-sectional nationwide online survey of the current Portuguese clinical practices for BoNT-A injections treating shoulder spasticity. Data were collected regarding the patient's spasticity cause, shoulder muscles treated, BoNT-A doses, guidance methods used, primary goal domains, treatment effectiveness, adverse effects, and recommendation of adjuvant therapy.Results: A total of 33 physical medicine and rehabilitation physicians were surveyed. Most of the surveyed doctors (90.91%; n = 30) identified post-stroke spasticity as the major condition for the use of BoNT-A injections in their clinical practice. The most frequently injected muscles for patterns that included shoulder adduction and internal rotation were the pectoralis major (100%; n = 33), subscapularis (93.94%; n = 31), latissimus dorsi (54.55%; n = 18), and teres major (24.24%; n = 8). In patterns including shoulder extension, the posterior deltoid (75.76%; n = 25), the long head of the triceps brachii (66.67%; n = 22), and the latissimus dorsi (48.48%; n = 16) were the most frequently targeted muscles. The primary goals of treatments were improvements in passive function (96.97%; n = 32), pain (84.85%; n = 28), active function (45.45%; n = 15), and range of motion (39.39%; n = 13). The overall impression of therapeutic efficacy was "good" (60.61%; n = 20), and adverse drug reactions were considered "very rare" (84.85%; n = 28) and "mild" (93.94%; n = 31). Ultrasound was used "always" and "most times" in 66.67% (n = 22) of cases. The maximum BoNT-A doses per muscle were lower than those in previously reported studies. Conventional kinesiotherapy was "always" recommended as adjuvant therapy after BoNT-A by 66.67% (n = 22) of physiatrists.Conclusions: This study provides the first nationwide Portuguese description of "real-life" clinical practices concerning the use of BoNT-A for shoulder spasticity. The selection of goal domains aligned with international results, and the targeted muscles were relatively similar. The use of ultrasound was high, and the maximum BoNT-A doses per muscle were lower than those in other reported clinical practices. The providers reviewed indicated high safety satisfaction with using BoNT-A for shoulder spasticity. Further development of clinical guidelines to standardize practices may be useful.

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“…Haubruck et al have studied the passive biomechanical properties of the muscle-tendon unit in the healthy mouse gastrocnemius muscle during stretching, and have reported a decrease of stiffness by 25% after the botulinum toxin ( 17 ). Howren et al have reported a significant reduction of the muscle-tendon ratio after 6 weeks of botulinum toxin injection by monitoring the changes in length of the gastroc/soleus, as well as the Achilles tendon unit based on ultrasound images in 36 human clubfoot patients ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

Characteristic Variation of Electromechanical Delay After the Botulinum Toxin Injection in Spastic Biceps Brachii Muscles

et al. 2022

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The objective of this study was to characterize the effects of intramuscular botulinum toxin (BT) injections on the electromechanical delay (EMD) in spastic human biceps muscles. The EMD is calculated as the time lag between the muscle activation onset, as recorded from the surface electromyogram (sEMG), and the onset of recorded force. In a cohort of chronic stroke survivors, we compared the computed EMD derived from the spastic (injected) biceps brachii with that from the contralateral muscle. Eight participants were tested before and up to 3 months after a BT injection. At each session, participants followed an isometric trapezoidal force trajectory at 50 and 30%, respectively, of the tested maximum voluntary contraction (MVC). Joint force and sEMG signals were recorded as well. The number of zero crossings (ZC) of the sEMG during the steady-state portion of the task was also computed. The EMD post-BT was found to increase by 64 ± 10% (at 50% MVC) and 93 ± 18% (at 30% MVC) when compared to pre-BT values, while the number of sEMG-ZC, the mean MVC values, and the force-EMD slope exhibited striking reductions. These parameters, calculated on the contralateral side, remained relatively constant across sessions, with the EMD significantly lower and the MVC values much higher. We discuss potential contributing factors to an increase in EMD values on the affected side, both pre- and post-BT. The observed co-variation across sessions of the increased EMD values with the decreased ZC estimates, a surrogate of motor outflow, and, potentially, more compliant muscle fascicles suggests that the altered motor unit (MU) behavior contributes, at least in part, to the delayed force production.

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Botulinum Neurotoxin A Injections Influence Stretching of the Gastrocnemius Muscle-Tendon Unit in an Animal Model

Cited by 9 publications

References 31 publications

Effects of botulinum toxin type A on non‐injected bi‐articular muscle include a narrower length range of force exertion and increased passive force

Effects of botulinum toxin type A on non‐injected bi‐articular muscle include a narrower length range of force exertion and increased passive force

Shoulder Spasticity Treatment With Botulinum Toxin: A Nationwide Cross-Sectional Survey of Clinical Practices

Characteristic Variation of Electromechanical Delay After the Botulinum Toxin Injection in Spastic Biceps Brachii Muscles

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