Ultrasound-guided Injection Of Botulinum Toxin Research Articles

Drooling in patients with severe cerebrovascular injury treated with ultrasound-guided botulinum toxin injections

Drooling in patients with severe cerebrovascular injury treated with ultrasound-guided botulinum toxin injections

Comparing a Transrectal Ultrasound-Guided with a Cystoscopy-Guided Botulinum Toxin A Injection in Treating Detrusor External Sphincter Dyssynergia in Spinal Cord Injury

The aim of this study was to compare the results of a transrectal ultrasound-guided botulinum toxin injection with those of a cystoscopy-guided method to the external urethral sphincter in treating detrusor external sphincter dyssynergia. A total of 18 suprasacral spinal cord-injured patients with detrusor external sphincter dyssynergia were included in the present study. A single dose of 100 IU botulinum toxin A was applied into the external urethral sphincter via a transrectal ultrasound-guided transperineal route. We retrospectively compared the outcome measurements with 20 suprasacral spinal cord-injured patients previously treated with the same dose of botulinum toxin through a cystoscopy-guided procedure. There were significant reductions in integrated electromyography and urethral pressure but not in detrusor pressure and leak point pressure after treatment. Postvoiding residuals were significantly decreased in the first, second, and third months in the cystoscopy group and in the first and second months in the transrectal ultrasound group. There were no significant differences between the groups in all of the outcome measures. This study demonstrates that transrectal ultrasound-guided transperineal botulinum toxin injection may be an alternative for a cystoscopy-guided injection. This alternative procedure provides clinicians with an innovative and less invasive method that is performed without requiring anesthesia or cystoscopy.

Ultrasound-guided botulinum toxin injections for treatment of drooling

To evaluate the efficacy of treatment of drooling by ultrasound-guided botulinum toxin injection of the salivary glands and to determine the optimal modalities of this procedure. This study is a retrospective review of patients treated for drooling by injection of 100 units of Botox(®) into the parotid and submaxillary glands between 2002 and 2008. Efficacy was evaluated by a quality of life questionnaire six weeks after the injections. One hundred and eleven injection sessions were performed in 70 patients aged one to 84 years with a beneficial effect in 66% of cases. The most effective protocol was injection of 20 units of botulinum toxin into each submaxillary gland and 30 units of toxin into each parotid gland. The treatment of drooling by Botox(®) injections into salivary glands is effective. The authors propose ultrasound-guided injection of both submaxillary glands and both parotid glands. These injections can be repeated in the case of recurrence of drooling.

Sa1480 Endoscopic Ultrasound Guided Botulinum Toxin Injection for the Treatment of Colon Outlet Obstruction With Hypertensive Internal Anal Sphincter

Outlet obstruction is a major cause of chronic constipation. The mainstay for therapy is biofeedback, but only 50% of patients respond initially and <25% have long-term response to biofeedback. Injection of botulinum toxin with digital guidance has been used for treatment of outlet obstruction with variable results. The use of endoscopic rectal ultrasound to assess the anatomy and target a hypertensive internal anal sphincter has not been described.

31 Ultrasound guided botulinum toxin injection into the submandibular gland as a treatment for hypersalivation in cerebral palsy

31 Ultrasound guided botulinum toxin injection into the submandibular gland as a treatment for hypersalivation in cerebral palsy

Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using a ultrasound-guided approach

The purpose of this study was to describe the technique, complications, and rate of symptom relief after ultrasound-guided botulinum toxin injection in subjects with suspected neurogenic thoracic outlet syndrome (NTOS). This study was IRB-approved and followed HIPPA guidelines. Subjects investigated for NTOS were identified via retrospective review of medical records. Procedures included botulinum toxin injections of the anterior scalene, pectoralis minor, and subclavius muscles performed under real-time ultrasound guidance. Technical success was defined as satisfactory muscle identification, intramuscular needle placement, and intramuscular delivery of medication. Follow-up was performed to determine procedure-related complications and therapy response using a binary assessment and modified visual analogue scale (VAS). Forty-one subjects with suspected NTOS underwent a total of 92 injections (58 anterior scalene, 33 pectoralis minor, and 1 subclavius muscle). Technical success was achieved in all procedures. No complications occurred. Symptom improvement occurred after 69% of procedures. The VAS before and after the procedure changed from 7.1 to 2.8 (P < 0.0001) respectively. The mean time to symptom improvement and duration of symptom improvement were 12 and 31 days respectively. Botulinum toxin injection under ultrasound guidance is a safe and well-tolerated procedure with a satisfactory rate of temporary symptom relief in subjects with suspected NTOS.

Ultrasound-guided injection of botulinum toxin A in the treatment of iliopsoas spasticity

Purpose Intramuscular injection of botulinum toxin A (BTX-A) is a common treatment for iliopsoas muscle spasticity, but it is not easy to position the needle in this muscle without guidance. In this paper we describe an ultrasound-guided technique for the intramuscular injection of BTX-A to treat spasticity of the iliopsoas muscle. Its effectiveness was assessed in 10 patients. Method and materials The ultrasound-guided technique for BTX-A injection was used on 10 patients. The needle was inserted into the muscle belly at an angle of 45° along the longitudinal axis of the muscle when allowed by patient's condition. Results In all cases, the iliopsoas muscle was easily identified and both the iliac and psoas components were assessed. Introduction of the needle and drug injection were entirely carried out under ultrasonographic guidance. The procedure was successful in all patients, even in those with a high-grade spasticity, and general anesthesia was not required. Conclusions This ultrasound-guided technique allows accurate guidance for the injection of BTX-A, and it can be considered as an alternate supportive therapy in patients with spasticity and dystonia.

Ultrasound-guided injection of botulinum toxin A (BTX-A) in spastic iliopsoas treatment

Ultrasound-guided injection of botulinum toxin A (BTX-A) in spastic iliopsoas treatment

Ultrasound‐guided injection of the iliopsoas muscle with botulinum toxin in camptocormia

Camptocormia is characterized by an abnormal posture of the trunk with pronounced flexion of the thoraco-lumbar spine during standing and walking, which abates in a supine position. Treatment options for camptocormia are limited and mostly futile. Here, we report on the ultrasound-guided ventral injection of botulinum toxin A (BTX) into deep portions of the iliopsoas muscle in four parkinsonian patients with camptocormia as chief complaint. Using this novel and safe application technique, all patients received 500-1,500 MU of BTX per side in 4-6 month intervals. Treatment was generally well tolerated. At the highest dose, all patients complained of mild weakness of hip flexion. Standardized physical exam at follow-up visits, as well as self-assessment of patients, failed to show a relevant and lasting improvement of posture. In conclusion, injection of BTX into the iliopsoas does not appear to be a promising approach for the treatment of parkinsonism-associated camptocormia.

Behandlung der Sialorrhoe bei beatmeten Patienten

Sialorrhea (drooling or excessive salivation) is a common problem in patients with progressive neurolomuscular diseases and bulbar palsy. Contributing factors are hypersecretion of saliva induced by cholinergic drugs and poor dental status. Non-invasive ventilation is often severely impaired in these patients. Treatment should be initiated with a thorough evaluation of the medication and of the oral status by an otorhinolaryngologist. As drooling is commonly caused by poor oral or pharyngeal neuromuscular control, swallowing therapy should be initiated by a speech therapist. Further treatment options are anticholinergic medications, botulinum toxin injections into the salivary gland, radiation and and surgical procedures. Whereas systemic anticholinergic medications lead often to side effects, the (ultrasound-guided) injection of botulinum toxin into the parotid and submandibular gland is a safe and effective method for controlling drooling for at least 2 months.

Voice Care and Research in Canada

Voice Care and Research in Canada

A prospective study of the effect of botulinum toxin A on masseteric muscle hypertrophy with ultrasonographic and electromyographic measurement

We evaluated the effect of botulinum toxin A on masseteric muscle hypertrophy by using ultrasound and electromyography. Five patients (four with bilateral and one with unilateral masseteric muscle hypertrophy) were studied prospectively. In each patient, ultrasound-guided percutaneous intramuscular injection of botulinum toxin A was carried out. The change in muscle bulk was evaluated using serial ultrasonography and the electrical activity was assessed with electromyography. All five patients (nine hypertrophic muscles) showed a good response, with the maximal effect of a 31% reduction in muscle bulk seen 3 months after treatment. The effect remained stable one year after injection for six of the hypertrophic muscles, whereas three muscles needed a second injection to maintain the atrophy. This preliminary prospective study suggests that botulinum toxin A is a safe alternative method of treating masseteric muscle hypertrophy. However, the effect may be temporary and further intramuscular injection may be required to maintain atrophy.