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15 pages, 3010 KiB

Open AccessFeature PaperArticle

Electromyographic and Joint Kinematic Patterns in Runner’s Dystonia

by Omar F. Ahmad, Pritha Ghosh, Christopher Stanley, Barbara Karp, Mark Hallett, Codrin Lungu and Katharine Alter

Toxins 2018, 10(4), 166; https://doi.org/10.3390/toxins10040166 - 20 Apr 2018

Cited by 14 | Viewed by 7024

Abstract

Runner’s dystonia (RD) is a task-specific focal dystonia of the lower limbs that occurs when running. In this retrospective case series, we present surface electromyography (EMG) and joint kinematic data from thirteen patients with RD who underwent instrumented gait analysis (IGA) at the [...] Read more.

Runner’s dystonia (RD) is a task-specific focal dystonia of the lower limbs that occurs when running. In this retrospective case series, we present surface electromyography (EMG) and joint kinematic data from thirteen patients with RD who underwent instrumented gait analysis (IGA) at the Functional and Biomechanics Laboratory at the National Institutes of Health. Four cases of RD are described in greater detail to demonstrate the potential utility of EMG with kinematic studies to identify dystonic muscle groups in RD. In these cases, the methodology for muscle selection for botulinum toxin therapy and the therapeutic response is discussed. Lateral heel whip, a proposed novel presentation of lower-limb dystonia, is also described. Full article

(This article belongs to the Special Issue Muscle Selection for BoNT)

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239 KiB

Open AccessArticle

Ultrasonographic Evaluation of Botulinum Toxin Injection Site for the Medial Approach to Tibialis Posterior Muscle in Chronic Stroke Patients with Spastic Equinovarus Foot: An Observational Study

by Alessandro Picelli, Alessio Baricich, Elena Chemello, Nicola Smania, Carlo Cisari, Marialuisa Gandolfi, Nicoletta Cinone, Maurizio Ranieri and Andrea Santamato

Toxins 2017, 9(11), 375; https://doi.org/10.3390/toxins9110375 - 18 Nov 2017

Cited by 12 | Viewed by 5611

Abstract

The tibialis posterior muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the tibialis posterior muscle is usually performed using anatomical landmarks [...] Read more.

The tibialis posterior muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the tibialis posterior muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the tibialis posterior muscle in chronic stroke patients with spastic equinovarus foot. Forty-six patients were evaluated at the affected middle lower leg medial surface with ultrasonography according to the following parameters: tibialis posterior muscle depth, thickness, and echo intensity. As to the spastic tibialis posterior, we found a mean muscle depth of 26.5 mm and a mean muscle thickness of 10.1 mm. Furthermore we observed a median tibialis posterior muscle echo intensity of 3.00 on the Heckmatt scale. The tibialis posterior muscle thickness was found to be inversely associated with its depth (p < 0.001) and echo intensity (p = 0.006). Furthermore, tibialis posterior muscle depth was found to be directly associated with its echo intensity (p = 0.004). Our findings may usefully inform manual needle placement into the tibialis posterior for the botulinum toxin treatment of spastic equinovarus foot in chronic stroke patients. Full article

(This article belongs to the Special Issue Muscle Selection for BoNT)

3161 KiB

Open AccessArticle

Spectral EMG Changes in Cervical Dystonia Patients and the Influence of Botulinum Toxin Treatment

by S. W. R. Nijmeijer, E. De Bruijn, R. Verhagen, P. A. Forbes, D. J. Kamphuis, R. Happee, M. A. J. Tijssen and J. H. T. M. Koelman

Toxins 2017, 9(9), 256; https://doi.org/10.3390/toxins9090256 - 23 Aug 2017

Cited by 5 | Viewed by 5599

Abstract

Botulinum toxin (BoNT) injections in the dystonic muscles is the preferred treatment for Cervical Dystonia (CD), but the proper identification of the dystonic muscles remains a challenge. Previous studies showed decreased 8–14 Hz autospectral power in the electromyography (EMG) of splenius muscles in [...] Read more.

Botulinum toxin (BoNT) injections in the dystonic muscles is the preferred treatment for Cervical Dystonia (CD), but the proper identification of the dystonic muscles remains a challenge. Previous studies showed decreased 8–14 Hz autospectral power in the electromyography (EMG) of splenius muscles in CD patients. Cumulative distribution functions (CDF’s) of dystonic muscles showed increased CDF₁₀ values, representing increased autospectral powers between 3 and 10 Hz, relative to power between 3 and 32 Hz. In this study, we evaluated both methods and investigated the effects of botulinum toxin. Intramuscular EMG recordings were obtained from the splenius, semispinalis, and sternocleidomastoid muscles during standardized isometric tasks in 4 BoNT-naïve CD patients, 12 BoNT-treated patients, and 8 healthy controls. BoNT-treated patients were measured 4–7 weeks after their last BoNT injections and again after 11–15 weeks. We found significantly decreased 8–14 Hz autospectral power in splenius muscles, but not in the semispinalis and sternocleidomastoid muscles of CD patients when compared to healthy controls. CDF₁₀ analysis was superior in demonstrating subtle autospectral changes, and showed increased CDF₁₀ values in all studied muscles of CD patients. These results did not change significantly after BoNT injections. Further studies are needed to investigate the origin of these autospectral changes in dystonia patients, and to assess their potential in muscle selection for BoNT treatment. Full article

(This article belongs to the Special Issue Muscle Selection for BoNT)

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Review

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3419 KiB

Open AccessFeature PaperReview

Muscle Selection for Focal Limb Dystonia

by Barbara Illowsky Karp and Katharine Alter

Toxins 2018, 10(1), 20; https://doi.org/10.3390/toxins10010020 - 29 Dec 2017

Cited by 6 | Viewed by 7499

Abstract

Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, [...] Read more.

Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, the large number of muscles in the hand and forearm, and the presence of compensatory actions in patients with dystonia add to the complexity of choosing muscles for injection. In this article, we discuss approaches to selecting upper and lower extremity muscles for chemodenervation treatment of limb dystonia. Full article

(This article belongs to the Special Issue Muscle Selection for BoNT)

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7122 KiB

Open AccessReview

Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures

by Katharine E. Alter and Barbara I. Karp

Toxins 2018, 10(1), 18; https://doi.org/10.3390/toxins10010018 - 28 Dec 2017

Cited by 38 | Viewed by 10573

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Muscle Selection for BoNT)

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454 KiB

Open AccessReview

Evidence to Use Botulinum Toxin Injections in Tension-Type Headache Management: A Systematic Review

by Mieszko Wieckiewicz, Natalia Grychowska, Marek Zietek, Gniewko Wieckiewicz and Joanna Smardz

Toxins 2017, 9(11), 370; https://doi.org/10.3390/toxins9110370 - 15 Nov 2017

Cited by 20 | Viewed by 6062

Abstract

Tension-type headache (TTH) is the most common type of chronic recurring head pain. It can occur twice as often in women as in men. It is the most common type of headache. Its lifetime prevalence is 30% to 78% in the general population. [...] Read more.

Tension-type headache (TTH) is the most common type of chronic recurring head pain. It can occur twice as often in women as in men. It is the most common type of headache. Its lifetime prevalence is 30% to 78% in the general population. TTH treatment should be multilevel. It often consists of taking pain medication, muscle relaxants, antidepressants, using biofeedback therapy, acupuncture, and attending behavioral therapy. Several clinical trials also suggest that botulinum toxin (BTX) may be an effective treatment option for such patients. The aim of this study was to evaluate if BTX can be used as a treatment method in TTH in the light of current medical literature. The authors searched the PubMed, EBSCOhost, OVID, Web of Knowledge, Cochrane Library and CINAHL databases to identify relevant publications. The authors finally included 11 papers—prospective and retrospective cohort studies. Among most of the selected studies, there was a significant correlation between using BTX and reduction of TTH pain intensity and severity. By analyzing qualified studies, it can be concluded that botulinum toxin seems to be effective in TTH management. Full article

(This article belongs to the Special Issue Muscle Selection for BoNT)

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1418 KiB

Open AccessFeature PaperReview

Chemodenervation of the Larynx

by Rachel Kaye and Andrew Blitzer

Toxins 2017, 9(11), 356; https://doi.org/10.3390/toxins9110356 - 2 Nov 2017

Cited by 9 | Viewed by 13789

Abstract

Botulinum neurotoxin (BoNT) has existed for thousands of years; however, it was not medically utilized until investigations into its therapeutic use began in sincerity during the late 1970s and 1980s. This, coupled with the reclassification of spasmodic dysphonia as a focal dystonia, led [...] Read more.

Botulinum neurotoxin (BoNT) has existed for thousands of years; however, it was not medically utilized until investigations into its therapeutic use began in sincerity during the late 1970s and 1980s. This, coupled with the reclassification of spasmodic dysphonia as a focal dystonia, led to the use of chemodenervation for this disorder, which has since become a refined technique. Indeed, due to its safety and efficacy, BoNT has been investigated in multiple neurolaryngology disorders, including spasmodic dysphonia, vocal tremor, and muscle tension dysphonia. BoNT has been shown to be a useful and safe adjunct in the treatment for these disorders and may reduce or eliminate oral pharmacotherapy and/or prevent the need for a surgical intervention. We present the historical background, development, proposed mechanisms of action, uses, and techniques for administering BoNT for laryngeal disorders, with a particular focus on spasmodic dysphonia. Full article

(This article belongs to the Special Issue Muscle Selection for BoNT)

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787 KiB

Open AccessReview

Neurophysiological Measures of Efficacy and Safety for Botulinum Toxin Injection in Facial and Bulbar Muscles: Special Considerations

by Mohammad Alimohammadi and Anna Rostedt Punga

Toxins 2017, 9(11), 352; https://doi.org/10.3390/toxins9110352 - 30 Oct 2017

Cited by 13 | Viewed by 21130

Abstract

Botulinum toxin (BoNT) injections into facial and bulbar muscles are widely and increasingly used as medical treatments for cervical and facial dystonia, facial hemispasm, correction of facial palsy, hyperhidrosis, as well as cosmetic treatment of glabellar lines associated with grief and anger. Although [...] Read more.

Botulinum toxin (BoNT) injections into facial and bulbar muscles are widely and increasingly used as medical treatments for cervical and facial dystonia, facial hemispasm, correction of facial palsy, hyperhidrosis, as well as cosmetic treatment of glabellar lines associated with grief and anger. Although BoNT treatment is generally considered safe, the diffusion of the toxin to surrounding muscles may result in complications, including difficulties swallowing, in a dose-dependent manner. The sensitivity of clinical examination for detecting adverse events after BoNT treatment is limited. Few reports have highlighted the potential effects on other muscles in the facial area due to the spreading of the toxin. The possibilities of spreading and thus unknown pharmacological BoNT effects in non-targeted muscles emphasise the importance of correct administration of BoNT in terms of dose selection, injection points, and appropriate effect surveillance. In this review article, we will focus on novel objective measures of efficacy and safety regarding BoNT treatment of facial muscles and the reasons why this is important. Full article

(This article belongs to the Special Issue Muscle Selection for BoNT)

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Other

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4 pages, 710 KiB

Open AccessReply

Reply to Comment on Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures. Toxins 2018, 10, 18—Quintessential Use of Ultrasound Guidance for Botulinum Toxin Injections

by Katharine E. Alter and Barbara I. Karp

Toxins 2018, 10(10), 400; https://doi.org/10.3390/toxins10100400 - 28 Sep 2018

Cited by 2 | Viewed by 3332

Abstract

We thank the authors for their detailed letter and salient comments related to our article on Ultrasound Guidance for botulinum toxin (BoNT) injections.[...] Full article

(This article belongs to the Special Issue Muscle Selection for BoNT)

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3 pages, 936 KiB

Open AccessComment

Comment on Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures. Toxins 2017, 10, 18—Quintessential Use of Ultrasound Guidance for Botulinum Toxin Injections—Muscle Innervation Zone Targeting Revisited

by Bayram Kaymak, Fevziye Ünsal Malas, Murat Kara, Arzu Yağız On and Levent Özçakar

Toxins 2018, 10(10), 396; https://doi.org/10.3390/toxins10100396 - 28 Sep 2018

Cited by 4 | Viewed by 3683

Abstract

Recently, the importance of targeting structures during botulinum neurotoxin applications has been discussed in a variety of disorders, including spasticity and dystonia. In this respect, the advantages of ultrasound imaging to traditional techniques have been emphasized. We would like underscore the importance of [...] Read more.

Recently, the importance of targeting structures during botulinum neurotoxin applications has been discussed in a variety of disorders, including spasticity and dystonia. In this respect, the advantages of ultrasound imaging to traditional techniques have been emphasized. We would like underscore the importance of ultrasound guidance, with targeting innervation zone(s) of the over-active muscles to achieve effective clinical outcomes. Additionally, we also clarify the difference between the terms—innervation zone (motor end plate) and motor point—which have been used by the authors as if they were the same. Further, we disagree with the authors about the intramuscular botulinum neurotoxin application techniques i.e., in-plane vs. out-of-plane whereby the former is, for sure, superior. Full article

(This article belongs to the Special Issue Muscle Selection for BoNT)

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