Abstract
Background: The aim of this study was to demonstrate an increase in muscle action potentials and an enhancement of the efficacy of botulinum toxin (BoNT) after mechanical leg vibration. Methods: A 53-year-old healthy male volunteer underwent vibration ergometry training (VET) every morning and every evening for 10 min for 14 days. Compound muscle action potential (CMAP) of the right (R) and left (L) extensor digitorum brevis (EDB) muscle was analyzed by supramaximal peroneal nerve stimulation before and after VET 12 times during the 14 days. Thereafter, VET was stopped and 20 U incobotulinumtoxin (incoBoNT/A) were injected into the right EDB. During the following 10 days, CMAP of both EDBs was tested 12 times. Results: Under VET, the CMAP of both EDBs significantly increased (L: p < 0.01; R: p < 0.01). During the first 14 days, CMAP of the left EDB before VET was significantly (<0.008) lower than 20 min later after VET. This was not the case for the better trained right EDB. After day 14, CMAP of the untreated left EDB further increased for 6 days and then decreased again. In the right EDB, BoNT-treated EDB CMAP rapidly and highly significantly (p < 0.0001) decreased during the first 48 h by about 90%, from a level of about 14 mV down to a plateau of around 1.5 mV. Conclusion: Local mechanical leg vibration has a short- and long-term training effect. Compared to other studies analyzing the reduction in EDB CMAPs after BoNT injections, the reduction of EDB CMAPs in the present study observed after combined application of BoNT and VET was much faster and more pronounced.
Highlights
Injections of botulinum neurotoxin (BoNT) are used for symptomatic treatment of a wide spectrum of disease entities [1]
We focus on mechanical leg vibration
The efficacy of botulinum toxin (BoNT) injections had been enhanced by vibration ergometry training (VET)
Summary
Injections of botulinum neurotoxin (BoNT) are used for symptomatic treatment of a wide spectrum of disease entities [1]. In a variety of indications, repetitive injections have to be performed to achieve a permanent level of improvement [2]. This bears the risk of antibody (AB) formation against the 750 kDa botulinum neurotoxin complex, against the hemagglutinin and non-hemiagglutinin complex proteins and against the. BoNT action (NABs [4,5]) If possible, their induction should be avoided in the course of BoNT treatment. High doses per session and duration of treatment are the main risk factors for NAB formation [3,6,7]. Methods which enhance the efficacy of BoNT and allow a reduction in BoNT dose per session are very much appreciated. The aim of this study was to demonstrate an increase in muscle action potentials and an enhancement of the efficacy of botulinum toxin (BoNT) after mechanical leg vibration
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