scholarly journals Triceps Surae Muscle Characteristics in Spastic Hemiparetic Stroke Survivors Treated with Botulinum Toxin Type A: Clinical Implications from Ultrasonographic Evaluation

Toxins ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 889
Author(s):  
Marco Battaglia ◽  
Lucia Cosenza ◽  
Lorenza Scotti ◽  
Michele Bertoni ◽  
Marco Polverelli ◽  
...  
Keyword(s):  
Botulinum Toxin Type A ◽  
Muscle Thickness ◽  
Type A ◽  
Triceps Surae ◽  
Medial Gastrocnemius ◽  
Stroke Survivors ◽  
Unaffected Side ◽  
Cross Sectional ◽  
Severe Spasticity ◽  
Hemiparetic Stroke

Equinovarus foot is one of the most commonly spasticity related conditions in stroke survivors, leading to an impaired gait and poor functional performances. Notably, spastic muscles undergo a dynamic evolution following typical pathophysiological patterns. Botulinum Neurotoxin Type A (BoNT-A) is the gold standard for focal spasticity treatment, and ultrasound (US) imaging is widely recommended to guide injections and monitor muscle evolution. The role of BoNT-A in influencing muscle fibroadipose degeneration is still unclear. In this study, we analyzed medial gastrocnemius (MG) and soleus (SOL) US characteristics (cross-sectional area, muscle thickness, pennation angle, and mean echo intensity) in 53 patients. MG and SOL alterations, compared to the unaffected side, depend on the spasticity only and not on the BoNT-A treatment. In functionally preserved patients (functional ambulation classification, FAC > 3; modified Ashworth scale, MAS ≤ 2), the ultrasonographic changes of MG compared to ipsilateral SOL observed in the paretic limb alone seems to be due to histological, anatomical, pathophysiological, and biomechanical differences between the two muscles. In subjects with poor walking capability and more severe spasticity, such ipsilateral difference was found in both calves. In conclusion, BoNT-A does not seem to influence muscle degeneration. Similar muscles undergo different evolution depending on the grade of walking deficit and spasticity.

scholarly journals Rectus Femoris Characteristics in Post Stroke Spasticity: Clinical Implications from Ultrasonographic Evaluation

Toxins ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 490
Author(s):  
Lucia Cosenza ◽  
Alessandro Picelli ◽  
Danila Azzolina ◽  
Marco Alessandro Minetto ◽  
Marco Invernizzi ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Botulinum Toxin Type A ◽  
Muscle Thickness ◽  
Rectus Femoris ◽  
Botulinum Toxin Type ◽  
Individual Variability ◽  
Muscle Quality ◽  
Stroke Survivors ◽  
Unaffected Side ◽  
Cross Sectional

In stroke survivors, rectus femoris (RF) spasticity is often implicated in gait pattern alterations such as stiff knee gait (SKG). Botulinum toxin type A (BoNT-A) is considered the gold standard for focal spasticity treatment. However—even if the accuracy of injection is crucial for BoNT-A efficacy—instrumented guidance for BoNT-A injection is not routinely applied in clinical settings. In order to investigate the possible implications of an inadequate BoNT-A injection on patients’ clinical outcome, we evaluated the ultrasound-derived RF characteristics (muscle depth, muscle thickness, cross-sectional area and mean echo intensity) in 47 stroke survivors. In our sample, we observed wide variability of RF depth in both hemiparetic and unaffected side of included patients (0.44 and 3.54 cm and between 0.25 and 3.16 cm, respectively). Moreover, our analysis did not show significant differences between treated and non-treated RF in stroke survivors. These results suggest that considering the inter-individual variability in RF muscle depth and thickness, injection guidance should be considered for BoNT-A treatment in order to optimize the clinical outcome of treated patients. In particular, ultrasound guidance may help the clinicians in the long-term follow-up of muscle quality.

High doses of a new botulinum toxin type A (NT-201) in adult patients with severe spasticity following brain injury and cerebral palsy

2014 ◽  
Vol 34 (3) ◽  
pp. 515-522 ◽  
Author(s):  
Domenico Intiso ◽  
Valentina Simone ◽  
Filomena Di Rienzo ◽  
Andrea Iarossi ◽  
Luigi Pazienza ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin ◽  
Brain Injury ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Adult Patients ◽  
Severe Spasticity ◽  
Nt 201 ◽  
High Doses

scholarly journals A cross-sectional structured survey of patients receiving botulinum toxin type A treatment for blepharospasm

2016 ◽  
Vol 367 ◽  
pp. 56-62 ◽  
Author(s):  
John Fezza ◽  
John Burns ◽  
Julie Woodward ◽  
Daniel Truong ◽  
Thomas Hedges ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Cross Sectional

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

Toxins ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 440
Author(s):  
Heli Sätilä
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Neuromuscular Junctions ◽  
Pediatric Population ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Triceps Surae ◽  
Injection Techniques ◽  
The Impact

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.

A cross-sectional structured survey of patients receiving botulinum toxin type A treatment for blepharospasm

2016 ◽  
Vol 22 ◽  
pp. e138 ◽  
Author(s):  
Daniel Truong ◽  
John Fezza ◽  
John Burns ◽  
Julie Woodward ◽  
Thomas Hedges ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Cross Sectional

scholarly journals Application of Combined Botulinum Toxin Type A and Modified Constraint-Induced Movement Therapy for an Individual With Chronic Upper-Extremity Spasticity After Stroke

2006 ◽  
Vol 86 (10) ◽  
pp. 1387-1397 ◽  
Author(s):  
Shu-Fen Sun ◽  
Chien-Wei Hsu ◽  
Chiao-Wen Hwang ◽  
Pei-Te Hsu ◽  
Jue-Long Wang ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Upper Extremity ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Movement Therapy ◽  
Botulinum Toxin Type ◽  
Constraint Induced Movement Therapy ◽  
Extremity Function ◽  
Severe Spasticity ◽  
Upper Extremity Function

Abstract Background and Purpose. Constraint-induced movement therapy (CIMT) is a promising intervention for retraining upper-extremity function after a stroke. The purpose of this case report is to describe the use of a combination of botulinum toxin type A (BtxA) and a modified CIMT program for a patient with severe spasticity who was unable to use his right upper extremity. Case Description. The 52-year-old patient, who had a stroke 4 years ago, did not meet the minimum motor criteria for CIMT benefit. After receiving BtxA injections targeting the elbow, wrist, and finger flexors, he completed a 4-week program of modified CIMT followed by a 5-month home exercise program. Outcomes. The patient exhibited improvement in muscle tone (the velocity-dependent resistance to stretch that muscle exhibits) and in scores on several upper-extremity function tests (Modified Ashworth Scale, Motor Activity Log, Wolf Motor Function Test, Action Research Arm Test, and Fugl-Meyer Assessment of Motor Recovery). He also reported making much progress in the functional use of the involved upper extremity. Discussion. In a patient with severe flexor spasticity and nonuse of the dominant upper extremity after a stroke, a combined treatment of BtxA and modified CIMT may have resulted in improved upper-extremity use.

scholarly journals Relationship between Muscle Cross-Sectional Area by MRI and Muscle Thickness by Ultrasonography of the Triceps Surae in the Sitting Position

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 166 ◽  
Author(s):  
Ryo Miyachi ◽  
Toshiaki Yamazaki ◽  
Naoki Ohno ◽  
Tosiaki Miyati
Keyword(s):  
Soleus Muscle ◽  
Young Male ◽  
Muscle Thickness ◽  
Cross Sectional Area ◽  
Triceps Surae ◽  
Neutral Position ◽  
Sitting Position ◽  
Sectional Area ◽  
Cross Sectional ◽  
Muscle Cross Sectional Area

The purpose of this study was to determine the differences in the muscle cross-sectional area (MCSA) of the triceps surae in the supine and sitting positions using magnetic resonance imaging (MRI), and the relationship between the MCSA of the triceps surae in the sitting position and muscle thickness (MT), assessed using MRI and ultrasonography, respectively. This study included 16 healthy young male participants. The measurement positions were 90° flexion of the knee joint and neutral position of the ankle joint in the sitting or supine positions. Using an open-configuration MRI system with a vertical gap and ultrasonography, we measured the MCSA and MT of the soleus muscle and the medial and lateral heads of the gastrocnemius muscle at three selected locations in the ventral part of the muscle. As a result, the 50% portion of the soleus muscle and the 25% and 50% portions of the gastrocnemius medial and lateral heads were higher in the sitting position than in the supine position. Furthermore, only 50% of the gastrocnemius medial head showed a correlation between the MCSA and MT. When using the MT of the triceps surae as an indicator of muscle volume in the sitting position, the muscle site should be considered.

scholarly journals Botulinum Toxin Type a for Rehabilitation after a Spinal Cord Injury: A Case Report

2009 ◽  
Vol 17 (1) ◽  
pp. 96-99 ◽  
Author(s):  
AS Naicker ◽  
SA Roohi ◽  
JLL Chan
Keyword(s):  
Botulinum Toxin ◽  
Weight Bearing ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Well Being ◽  
Botulinum Toxin Type ◽  
Pressure Sore ◽  
Lower Limbs ◽  
Severe Spasticity ◽  
Cord Injury

A 56-year-old man became quadriplegic, bed bound, and carer-dependent secondary to cervical osteomyelitis. Three years later, he presented with generalised spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his hips and knees prevented ischial sitting. Injections of botulinum toxin type A to both hamstrings and gastrosoleuii controlled the flexor spasticity of his lower limbs and facilitated rehabilitation and wound healing through proper positioning, wound care, stretching, and weight-bearing exercises. A few weeks later, the patient could better position himself in bed (prone lying) and on his wheelchair (ischial sitting). His spasm-related pain lessened and his mobility and activities of daily living improved. The sacral pressure sore healed completely a few months later. The patient could sleep better, feed with set-up and adaptive aids, groom, dress, and transfer himself with minimal assistance. The effects of botulinum toxin extended beyond just spasticity reduction. His upper extremity function, mobility, and social well-being were all improved through better positioning.

Sign in / Sign up

Export Citation Format

Share Document