Does botulinum toxin injection site determine outcome in post-stroke plantarflexion spasticity? Comparison study of two injection sites in the gastrocnemius muscle: a randomized double-blind controlled trial

Im, Sun; Park, Joo Hyun; Son, Seong Kon; Shin, Jae‐Eun; Cho, Sae Hoon; Park, Geun-Young

doi:10.1177/0269215513514983

Cited by 18 publications

(26 citation statements)

References 38 publications

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“…found that the efficacy of MEP‐targeted BoNT‐A injections was superior to that of non‐targeted injections in spastic elbow flexors of adults post stroke. In a recent study of the same subject group, Im et al . could not replicate these results for the gastrocnemius muscle.…”

Section: Discussionmentioning

confidence: 83%

“…In order to understand whether or not the specific site of gracilis muscle injection influences the effects of BoNT‐A on muscle spasticity, a double‐blind, randomized controlled trial was set up to compare two injection techniques: MEP‐targeted injection and the widely used proximal injection technique . Previous studies comparing muscle injection sites have used surface electromyography (sEMG) during maximum voluntary contractions (MVCs) to record the denervation effects of BoNT‐A . However, there have been no studies reporting the effects of injection site on spasticity.…”

mentioning

confidence: 99%

“…12 Previous studies comparing muscle injection sites have used surface electromyography (sEMG) during maximum voluntary contractions (MVCs) to record the denervation effects of BoNT-A. 6,13 However, there have been no studies reporting the effects of injection site on spasticity.…”

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confidence: 99%

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Motor endplate‐targeted botulinum toxin injections of the gracilis muscle in children with cerebral palsy

Campenhout

Bar‐On

Desloovere

et al. 2015

Develop Med Child Neuro

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Aim Intramuscular botulinum toxin‐A (BoNT‐A) injections reduce spasticity by blocking neurotransmission at the motor endplate (MEP). The goal of this study was to assess the reduction in spasticity achieved by injecting BoNT‐A at different sites of the gracilis muscle. Method Thirty‐four gracilis muscles, in 27 children (10 females and 17 males, mean age of 8.6y [SD 2.5y]) with spastic cerebral palsy (unilateral and bilateral, Gross Motor Function Classification System [GMFCS] levels I–IV), were randomly assigned to one of two groups. In one group BoNT‐A was injected proximally (at a site 25% of the distance from the pubic tubercle and the medial epicondyle) and in the other it was injected at the MEP zones (half of the dose was administered at 30% of this distance and half at 60%). Spasticity was assessed before and after BoNT‐A injection using simultaneous measurements of surface electromyography (sEMG) and angular velocity during passive muscle stretch applied at different velocities. The primary outcome measure included the velocity‐dependent change in average root mean square electromyography (RMS‐EMG). Secondary outcome was assessed with the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). Results Spasticity decreased more in MEP‐targeted muscles than in proximally injected muscles, as demonstrated by a larger reduction in average RMS‐EMG values (p=0.04), though this difference was not found with the MAS or MTS. Interpretation The results suggest that BoNT‐A injection of the gracilis at sites with a high concentration of MEPs is effective at reducing spasticity. These preliminary findings should be confirmed by larger studies. In the case of long muscles, such as the gracilis, the injection site is important.

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Section: Discussionmentioning

confidence: 83%

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confidence: 99%

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Motor endplate‐targeted botulinum toxin injections of the gracilis muscle in children with cerebral palsy

Campenhout

Bar‐On

Desloovere

et al. 2015

Develop Med Child Neuro

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“…Compared to other current treatments, it must to be noted that EOAz enhanced contractile performance after a short period of 10 daily dermal applications. The golden standard treatment with botulinum toxin A induced similar (discrete) changes in sEMG recordings of spastic gastrocnemius after 8-week administration, although the clinical parameters were considerably improved [39]. It indicates that small modifications in sEMG can reflect important functional recovery.…”

Section: Discussionmentioning

confidence: 91%

The Effect of Alpinia zerumbet Essential Oil on Post‐Stroke Muscle Spasticity

Maia

Dantas

Filho

et al. 2015

Basic Clin Pharma Tox

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The essential oil of Alpinia zerumbet (EOAz) presents myorelaxant and antispasmodic actions on cardiac and smooth muscles. The aim of this study was to investigate the effect of EOAz on the skeletal muscle contraction in post-stroke spasticity. Fifteen adults with unilateral hemiparesis and spasticity resulting from stroke were submitted to surface electromyography readings of the gastrocnemius muscle, before and after 10 daily applications (dermal 0.05 mL per muscle belly) of EOAz. The healthy contralateral muscles without applying the oil were used as controls. The analysis showed that, in both lateral and medial gastrocnemius, the values of all studied variables (root mean square, maximum amplitude and median power frequency) were significantly decreased in pathological legs during muscle contraction (Wilcoxon test, p < 0.05). Moreover, spastic muscles presented different results before and after dermal application of EOAz: The mean values of root mean square and median power frequency were significantly increased in lateral and medial gastrocnemius, and also, the maximum amplitude increased in medial gastrocnemius (Mann-Whitney test, p < 0.05). The results suggest that EOAz acts in the skeletal spastic muscle contraction by promoting relaxation and improvement of the muscular performance. Thus, the EOAz can be useful for the clinical management of secondary effects in patients with cerebral vascular disease.The Alpinia speciosa K. Schum., synonymy zerumbet, is a plant of Asian origin and member of the Zingiberaceae family [1,2]. It is widely distributed in Brazil, where it is popularly called 'colony'. The essential oil and extracts obtained from aerial parts of Alpinia zerumbet present antihypertensive [3][4][5][6], antioxidant [7,8] and anxiolytic [9] activities, among others.Some actions of essential oil of Alpinia zerumbet (EOAz) and its main constituents have been reported on the nervous and muscular systems. In experimental studies, the EOAz presented anticholinergic, antispasmodic and myorelaxant effects on small intestine of rodents [10,11]; promoted a dose-dependent blockade of the compound action potential of the rat sciatic nerve [12]; and presented endothelium-dependent vasorelaxant effect [4,13]. Also, the oil induced a cardiodepressive effect in vitro, this action being related to calcium current blockade [14]. These findings raise the possibility that the EOAz can act on altered contractile properties of skeletal fibres.In stroke patients, spasticity occurs as a result of spinal reflex dysfunction and is clinically related to abnormal increased muscle tone [15] and consequent impaired muscular performance [16]. This illness causes disabilities in more than 50% of affected people and impacts family and healthcare systems [17]. The current treatments are not fully effective, and new therapeutic strategies are desirable.From the hypothesis that EOAz could be a complementary medicine to treat spasticity by presenting relaxant action, this work aimed to investigate the effects of the derm...

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“…Experimental studies used the ABILOCO as an outcome measure and reported changes in scores above 0.55 logit. Im et al evaluated the effects of botulinum toxin injection in two sites of the lower limbs of stroke patients and found mean changes of 1.7 and 1.9 logits ( P < .01), respectively. Caty et al investigated the effects of botulinum toxin injections in several spastic muscles of patients with chronic stroke who had stiff knee gait and found increases in scores ranging from 2.2 to 3.2 logits ( P = .03).…”

Section: Discussionmentioning

confidence: 99%

Test‐Retest Reliability of the ABILOCO Questionnaire in Individuals with Stroke

Menezes

Avelino

Faria‐Fortini

et al. 2019

PM&R

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Background The ABILOCO is a self‐reported questionnaire, specific for individuals with stroke, for the assessment of ability of locomotion. The ABILOCO has been investigated using the Rasch model and has shown satisfactory measurement properties. However, its test‐retest reliability has not been investigated. Objective To investigate the test‐retest reliability, that is, agreement, systematic and random variability of the ABILOCO Questionnaire in individuals with chronic stroke. Design A test‐retest reliability study. Setting Research laboratory. Participants Thirty‐one individuals (21 men and 10 women; mean age, 60 years), who had poststroke hemiparesis. Intervention Not applicable. Main Outcome Measurement The ABILOCO was applied twice, on two occasions, 5 to 7 days apart. Test‐retest reliability was investigated, as follows: agreement by the calculation of intraclass correlation coefficients (ICCs); systematic variability by the change in the mean; random variability by the standard error of measurement (SEM) and smallest real difference (SRD). Results Two outliers were identified in the sample. The ICC values for the whole sample were 0.76 (CI 95% 0.56 to 0.88), whereas the SEM (SEM%) and SRD (SRD%) were 0.55 (21%) and 1.52 (58%), respectively. Conclusion The ABILOCO showed to be reliable to be applied within clinical and research contexts for the assessment of changes in locomotion ability of a group of individuals with chronic stroke. However, it appears to be less suitable to detect changes at individual levels. Level of Evidence III.

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Does botulinum toxin injection site determine outcome in post-stroke plantarflexion spasticity? Comparison study of two injection sites in the gastrocnemius muscle: a randomized double-blind controlled trial

Abstract: Botulinum toxin A injection was associated with a significant improvement from baseline to week 8 in both treatment groups, however, no significant difference between the 2 groups was observed, based on the electrophysiological and clinical parameters employed in this study.

Cited by 18 publications

References 38 publications

Motor endplate‐targeted botulinum toxin injections of the gracilis muscle in children with cerebral palsy

Motor endplate‐targeted botulinum toxin injections of the gracilis muscle in children with cerebral palsy

The Effect of Alpinia zerumbet Essential Oil on Post‐Stroke Muscle Spasticity

Test‐Retest Reliability of the ABILOCO Questionnaire in Individuals with Stroke

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