Infiltración de toxina botulínica tipo A en espasticidad y distonía cervical. La morfología muscular, la gran olvidada

Abstract

IntroductionBotulinum toxin typeA is used to treat spasticity and dystonia. However, its relationship with muscle morphology has not been studied. The action mechanism of botulinum toxin is based on the inhibition of acetylcholine release. Therefore, larger doses of toxin would be needed to treat larger muscles. This study aims to establish whether there is a discrepancy between muscle morphology and the botulinum toxin doses administered. MethodsWe dissected, and subsequently measured and weighed, muscles from the upper and lower limbs and the head of a fresh cadaver. We consulted the summary of product characteristics for botulinum toxin typeA to establish the recommended doses for each muscle and calculated the number of units infiltrated per gramme of muscle. ResultsDifferent muscles present considerable morphological variability, and the doses of botulinum toxin administered to each muscle are very similar. We observed great variability in the amount of botulinum toxin administered per gramme of muscle, ranging from 0.3U/g in the biceps femoris to 14.6U/g in the scalene muscles. The mean dose was 2.55U/g. The doses administered for nearly all lower limb muscles were below this value. ConclusionsThere are significant differences in morphology between the muscles of the lower limbs, upper limbs, and head, but similar doses of botulinum toxin are administered to each muscle. These differences result in great variability in the number of units of botulinum toxin administered per gramme of muscle.