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Chapter 18 - The Use of Botulinum Neurotoxin in Spasticity Using Ultrasound Guidance

Published online by Cambridge University Press:  02 November 2023

By
Andrea Santamato ,
Alessio Baricih  and
Alessandro Picelli
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett ,
Christopher Zachary  and
Mayank Pathak
Daniel Truong
Affiliation:
University of California, Riverside
Dirk Dressler
Affiliation:
Hannover Medical School
Mark Hallett
Affiliation:
National Institutes of Health (NIH)
Christopher Zachary
Affiliation:
University of California, Irvine
Mayank Pathak
Affiliation:
Truong Neuroscience Institute
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Summary

Botulinum neurotoxin (BoNT) injection is an effective treatment of spasticity in upper and lower limbs. Accuracy of injection needle placement in target muscles is of great importance in maximizing effectiveness of the treatment, and avoiding both treatment failure and adverse events such as weakening of adjacent musculature. Various guidance techniques improve effectiveness and avoid side effects, including anatomical landmark location and palpation, electromyographic guidance, and ultrasound guidance. In recent years, the availability of portable ultrasound devices has facilitated the application of ultrasound guidance, which is quick, painless, and now readily available. This chapter uses photographs, anatomical illustrations, and ultrasound images to illustrate injection techniques for specific muscles involved in the common patterns of spastic posturing.

Keywords

Spasticitybotulinum neurotoxinBoNTultrasound guidance
Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 133 - 162
Publisher: Cambridge University Press
Print publication year: 2023

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References

Berweck, S, Schroeder, AS, Fietzek, UM, Heinen, F (2004). Sonography-guided injection of botulinum toxin in children with cerebral palsy. Lancet, 17, 249–50.Google Scholar
Bradley, M, O’Donnell, P (2002). Atlas of Musculoskeletal Ultrasound Anatomy. Cambridge: Cambridge University Press.Google Scholar
Childers, MK (2003). The importance of electromyographic guidance and electrical stimulation for injection of botulinum toxin. Phys Med Rehabil Clin N Am, 14, 781–92.Google Scholar
Cosgrove, D (1992). Ultrasound: general principles. In Grainger, RG, Allison, DJ (eds.) Diagnostic Radiology. Edinburgh: Churchill Livingstone, pp. 65–77.Google Scholar
Heckmatt, JZ, Dubowitz, V, Leeman, S (1980). Detection of pathological change in dystrophic muscle with B-scan ultrasound imaging. Lancet, 1, 1389–90.Google Scholar
Kwon, JY, Hwang, JH, Kim, JS (2010). Botulinum toxin A injection into calf muscles for treatment of spastic equinus in cerebral palsy: a controlled trial comparing sonography and electric stimulation-guided injection techniques: A preliminary report. Am J Phys Med Rehabil, 89, 279–86.CrossRefGoogle ScholarPubMed
Mayer, NH, Esquenazi, A, Childers, MK (2002). Common patterns of clinical motor dysfunction. In Mayer, NH, Simpson, DM (eds.) Spasticity: Etiology, Evaluation, Management and the Role of Botulinum Toxin. New York: WE MOVE, pp. 16–26.Google Scholar
Pillen, S (2010). Skeletal muscle ultrasound. Eur J Transl Myol, 1, 145–55.Google Scholar
Py, AG, Zein Addeen, G, Perrier, Y, Carlier, RY, Picard, A (2009). Evaluation of the effectiveness of botulinum toxin injections in the lower limb muscles of children with cerebral palsy. Preliminary prospective study of the advantages of ultrasound guidance. Ann Phys Rehabil Med, 52, 215–23.Google Scholar
Westhoff, B, Seller, K, Wild, A, Jaeger, M, Krauspe, R (2003). Ultrasound-guided botulinum toxin injection technique for the iliopsoas muscle. Dev Med Child Neurol, 45, 829–32.Google ScholarPubMed
Wild, JJ, Neal, D (1951). Use of high-frequency ultrasonic waves for detecting changes of texture in living tissues. Lancet, 1, 655–7.Google Scholar
Willenborg, MJ, Shilt, JS, Smith, BP et al. (2002). Technique for iliopsoas ultrasound guided active electromyography-directed botulinum a toxin injection in cerebral palsy. J Pediatr Orthop, 22, 165–8.Google Scholar
Yang, EJ, Rha, DW, Yoo, JK, Park, ES (2009). Accuracy of manual needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography. Arch Phys Med Rehabil, 90, 741–4.Google Scholar

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