Pain during injections of botulinum toxin in children: Influence of the localization technique

Bayon-Mottu, M.; Gambart, G.; Deries, X.; Tessiot, C.; Rodet-Belarbi, Isabelle; Dinomais, Mickaël

doi:10.1016/j.rehab.2014.09.010

Cited by 8 publications

(5 citation statements)

References 12 publications

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“…Ultrasound has become a very helpful and widely used tool in pediatrics, offering a visually controlled option to potentate the accuracy of injections in children [52]. The advantages are less pain, the possibility to control the injection placement even with anatomic variations, the differentiation of neighboring structures (muscles, vessels, nerves, and bones), not requiring co-operation or sedation, and the choice of documenting the site and volume of the injected toxin [15,53]. However, ultrasound does not help in finding the MEPs.…”

Section: Techniques For Localizing Muscles and Endplate Zonesmentioning

confidence: 99%

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Sätilä

2020

Toxins

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Botulinum toxin type A (BTXA) has been used for over 25 years in the management of pediatric lower and upper limb hypertonia, with the first reports in 1993. The most common indication is the injection of the triceps surae muscle for the correction of spastic equinus gait in children with cerebral palsy. The upper limb injection goals include improvements in function, better positioning of the arm, and facilitating the ease of care. Neurotoxin type A is the most widely used serotype in the pediatric population. After being injected into muscle, the release of acetylcholine at cholinergic nerve endings is blocked, and a temporary denervation and atrophy ensues. Targeting the correct muscle close to the neuromuscular junctions is considered essential and localization techniques have developed over time. However, each technique has its own limitations. The role of BTXA is flexible, but limited by the temporary mode of action as a focal spasticity treatment and the restrictions on the total dose deliverable per visit. As a mode of treatment, repeated BTXA injections are needed. This literature reviewed BTXA injection techniques, doses and dilutions, the recovery of muscles and the impact of repeated injections, with a focus on the pediatric population. Suggestions for future studies are also discussed.

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Section: Techniques For Localizing Muscles and Endplate Zonesmentioning

confidence: 99%

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Sätilä

2020

Toxins

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“…Pain was evaluated immediately post-procedure using a visual analog scale and a behavior based scale (FLACC (Face, Leg, Activity, Cry, Consolability). Children and or their caregivers reported a significantly lower level of pain with procedures guided with US compared to those with E-Stim guidance [ 66 ].…”

Section: Guidance Methods For Bont Injections: Levels Of Evidencementioning

confidence: 99%

Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures

Alter

Karp

2017

Toxins

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Injections of botulinum neurotoxins (BoNTs) are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Accurately targeting the structure for injection is one of the principle goals when performing BoNTs procedures. Traditionally; injections have been guided by anatomic landmarks; palpation; range of motion; electromyography or electrical stimulation. Ultrasound (US) based imaging based guidance overcomes some of the limitations of traditional techniques. US and/or US combined with traditional guidance techniques is utilized and or recommended by many expert clinicians; authors and in practice guidelines by professional academies. This article reviews the advantages and disadvantages of available guidance techniques including US as well as technical aspects of US guidance and a focused literature review related to US guidance for chemodenervation procedures including BoNTs injection.

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“…Also pointed out by Henzel et al [4], US guidance requires less probing and searching for the targeted muscle than EMG, which reduces the number of needle sticks and pain with the injection. Bayon‐Mottu et al [5] demonstrated that children reported more pain with ES‐guided injections than US‐guided lower extremity injections.…”

Section: Case Scenariomentioning

confidence: 99%

Should Ultrasound Be Used Routinely to Guide Botulinum Toxin Injections for Spasticity?

McGuire

Heath

O’Dell

2016

PM&R

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Background Shoulder dysfunction is common in persons with spinal cord injury (SCI) with an incidence of up to 63%. Dysfunction is a result of muscle imbalances, specifically denervated rotator cuff muscles that are repetitively used during manual wheelchair propulsion. Objective To determine which arm stroke technique, pump (P) or semicircular (SC), is most energy efficient for long periods of propulsion. Design A randomized study with repeated measures observations. Setting The study was performed at an institutional gait analysis laboratory. Participants 18 able‐bodied (AB) male participants were studied and randomized into one of 2 conditions, SC or P. Methods Shoulder muscle fatigue was measured by changes in Borg CR10 Rate of Perceived Exertion (Borg RPE) and upper extremity strength via a handheld dynamometer. Participants were studied and assigned into one of 2 conditions of wheelchair arm propulsion patterns, SC or P group, and propelled on a wheelchair treadmill for 10 minutes. Main Outcome Measures The primary outcomes included recordings of Borg RPE scale during continuous wheelchair propulsion and pre‐ and post‐test dynamometer testing means for bilateral elbow and shoulder extension. Analysis of covariance, t‐tests, and Kruskal‐Wallis tests were used in analyzing data. Results Although not significant (P = .23), the Borg RPE scores for the SC condition were consistently higher than the scores for the P condition. In addition, the dynamometer pre‐ and post‐test readings demonstrated a larger decrease for the SC condition participants than for the P condition participants, but were not statistically significant. Conclusions These data demonstrate that the SC wheelchair propulsion pattern appears to be more fatiguing to shoulder muscles than the P propulsion pattern. However, more data would need to be collected to find a significant difference. Level of Evidence II

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Pain during injections of botulinum toxin in children: Influence of the localization technique

Abstract: When compared to ultrasound detection, localization by electrostimulation appears to increase the overall pain caused during injections of botulinum toxin in children.

Cited by 8 publications

References 12 publications

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures

Should Ultrasound Be Used Routinely to Guide Botulinum Toxin Injections for Spasticity?

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