Ultrasound-guided Injection Of Botulinum Toxin Research Articles

Ultrasound-guided botulinum toxin injections of salivary glands in cerebral palsy children with sialorrhea

Objective: Excessive salivation and drooling are distressing problems that affect both children and their families. Salivary gland botulinum toxin injection is a widely studied therapeutic method for treating sialorrhea. The proper protocol for such treatment modality is an area of interest for researchers. This study set out to assess the success of ultrasound-guided botulinum toxin injections in either the submandibular or combined with parotid salivary glands for children with cerebral palsy suffering from sialorrhea, while also identifying factors that predict a positive treatment outcome. Method: This cross-sectional study included 30 children with cerebral palsy who have Sialorrhea. Ultrasound-guided botulinum toxin injections of submandibular salivary glands alone or combined with parotid glands were done. Drooling was evaluated using Drooling Rating Scale, Drooling Impact Scale, and 5-minute Drooling Quotient. Children were followed up weekly for 12 weeks after botulinum toxin injections. Result: All children showed a significant decline in drooling and sufficient caregivers’ satisfaction for the first 8 weeks after botulinum toxin injections, with gradual worsening of drooling later in 60% of children. Assessment scores were significantly lower in those who received combined parotid and submandibular injections than those who received submandibular gland injections alone. Changes in drooling scores have a significant negative correlation with the severity of motor disabilities. Conclusion: Submandibular salivary gland injection alone has a satisfactory response in decreasing drooling in children with cerebral palsy. However, a combined injection of both parotid and submandibular salivary glands gives a better response for at least 8 weeks without complications. This study not only addresses the clinical effectiveness of botulinum toxin injections in managing sialorrhea in children with cerebral palsy but also opens avenues for improved dietary strategies. Keywords: botulinum toxin; salivary gland; sialorrhea; cerebral palsy

Ultrasound-guided Botulinum Toxin Injection into the Salivary Glands for Treating Sialorrhea in a Case of Small-cell Lung Cancer

Ultrasound-guided Botulinum Toxin Injection into the Salivary Glands for Treating Sialorrhea in a Case of Small-cell Lung Cancer

Successful Treatment of Achalasia With Endoscopic Ultrasound–Guided Botulinum Injection in Setting of Esophageal Varices

ABSTRACT Achalasia in a patient with liver cirrhosis decompensated by esophageal varices is an extremely rare presentation with complex management implications. We describe a case of achalasia and malnutrition in a male patient with esophageal varices treated by endoscopic ultrasound–guided botulinum toxin injection. After treatment, the patient's dysphagia dramatically improved, and his weight loss stabilized, which allowed an important window to remove the barrier of nutritional status for transplant candidacy. Endoscopic ultrasound–guided botulinum toxin injection to avoid varices is potentially a safer method for delivering botulinum toxin injection to the lower esophageal sphincter in a patient with esophageal varices.

Solely Ultrasound-guided Botulinum Toxin Injection in the Cricopharyngeus Muscle: Successful Treatment in a Patient of Chronic Dysphagia Following Lateral Medullary Syndrome

Botulinum toxin (BTX) injection is a widely used procedure for the treatment of the dysfunction of the upper oesophageal sphincter. Although injection can be guided by ultrasound (US), electromyography or computed tomography, the most convenient option will be solely US-guided injection. No studies yet observed the effectiveness of solely US-guided BTX injection in the cricopharyngeus muscle (CPM) in dysphagia following lateral medullary syndrome (LMS). In this report, 50 U of BTX type-A was given in the right CPM in a patient of right LMS with chronic severe dysphagia, under the guidance of US. Dysphagia Outcome Severity Scale score improve from 1 to 6, Functional Oral Intake Scale score improved from 1 to 6 and penetration-aspiration scale score improved from 7 to 2 at 2 months follow-up. Solely US-guided BTX injection may be a feasible option for many rehabilitation units in managing dysphagia following LMS.

Efficacy of Ultrasound-Guided Injection of Botulinum Toxin, Ozone, and Lidocaine in Piriformis Syndrome.

Background: Piriformis syndrome (PS) is a painful musculoskeletal condition characterized by a deep gluteal pain that may radiate to the posterior thigh and leg. This study was designed to compare the effectiveness of ozone and BTX to lidocaine injection in treating piriformis syndrome that was resistant to medication and/or physical therapy. Study design: Between November 2018 and August 2019, we involved eighty-four subjects diagnosed with piriformis syndrome in a double-blinded, prospective, randomized comparative study to receive an ultrasound-guided injection of lidocaine (control group), botulinum toxin A, or local ozone (28 patients each group) in the belly of the piriformis muscle. Pain condition evaluated by the visual analog score (VAS) was used as a primary outcome, and the Oswestry Disability Index (ODI) as a secondary outcome, before, at one month, two months, three months, and six months following the injection. Results: The majority (58.3%) of patients were male, while (41.7%) were female. At one month, a highly significant decrease occurred in VAS and ODI in the lidocaine and ozone groups compared to the botulinum toxin group (p < 0.001). At six months, there was a highly significant decrease in VAS and ODI in the botulinum toxin group compared to the lidocaine and ozone groups (p < 0.001). Conclusion: Botulinum toxin may assist in the medium- and long-term management of piriformis syndrome, while lidocaine injection and ozone therapy may help short-term treatment in patients not responding to conservative treatment and physiotherapy.

Intra-articular botulinum toxin A injection for painful base-of-thumb osteoarthritis: a double-blind, randomised, controlled, phase 3 trial (RHIBOT).

Intra-articular botulinum toxin A injection might have analgesic effects in patients with joint diseases. We aimed to compare the effects of intra-articular botulinum toxin A injection with those of intra-articular saline injection for patients with painful base-of-thumb osteoarthritis. RHIBOT was a double-blind, randomised, controlled, phase 3 trial conducted at Cochin Hospital, Paris, France. We recruited adult patients with x-ray evidence of trapeziometacarpal osteoarthritis who fulfilled the 1990 American College of Rheumatology criteria for hand osteoarthritis and reported a pain intensity score of at least 30 on an 11-point numeric rating scale (0: no pain to 100: maximal pain). Participants were randomly assigned (1:1), using a computer-generated randomisation list with permuted blocks of variable size (4 or 6), to receive an ultrasound-guided injection of either botulinum toxin A (50 Allergan units) in 1 mL of saline (experimental group) or 1 mL of saline alone (control group) in the trapeziometacarpal joint, in addition to custom-made rigid splinting. The primary outcome was the mean change from baseline in base-of-thumb pain in the previous 48 h on a numeric rating scale at 3 months after injection, analysed by intention to treat. This study is registered with ClinicalTrials.gov, NCT03187626. Between Nov 2, 2018, and Nov 3, 2020, we assessed 370 individuals for eligibility and recruited 60 (16%) participants (mean age 64·9 years [SD 9·4], 47 [78%] women and 13 [22%] men), of whom 30 (50%) participants were randomly assigned to the experimental group and 30 (50%) to the control group. At baseline, base-of-thumb pain score was 60·0 of 100·0 (SD 15·9). At 3 months, the mean reduction in base-of-thumb pain was -25·7 (95% CI -35·5 to -15·8) in the experimental group and -9·7 (-17·1 to -2·2) in the control group (absolute difference -16·0 [-28·1 to -3·9]; p=0·043). Overall, 51 adverse events were reported in both groups: 27 (53%) in the experimental group and 24 (47%) in the control group. During follow-up, 14 (47%) participants in the experimental group and two (7%) participants in the control group reported mild transient motor deficit of the thenar muscle. No serious adverse events were reported. Botulinum toxin A could be considered as a fast-acting, intra-articular therapy targeting chronic pain in individuals with base-of-thumb osteoarthritis. Future studies are needed to investigate the potential mechanism of the effects observed in this trial, to replicate our findings, and to assess the effects of repeated injections over time and their clinical effectiveness, including an analysis of cost-effectiveness. Assistance Publique-Hôpitaux de Paris.

Comparison studies of ultrasound-guided botulinum toxin injection and balloon catheter dilatation in the treatment of neurogenic cricopharyngeal muscle dysfunction.

Cricopharyngeal muscle dysfunction (CPD) management has been challenging in clinical practice. To compare the efficacy and safety of ultrasound-guided botulinum toxin injection and balloon catheter dilatation in treating CPD. Forty patients with CPD were randomly divided into two groups, namely the botulinum toxin injection group (BTX group) and balloon dilatation group (BD group). Patients in the BTX group received a single ultrasound-guided injection of 50 units of botulinum toxin type A, while the BD group received dilatation therapy five times per week, consecutively for two weeks. Relative opening percentage of the upper esophageal sphincter (UES), the penetration-aspiration scale (PAS), and the Dysphagia Outcome Severity Scale (DOSS) were evaluated by a videofluoroscopic swallowing study (VFSS) at baseline, 1-month, and 3-months posttreatment. The Functional Oral Intake Scale (FOIS) and Standardized Swallowing Assessment (SSA) were also used to evaluate participants' swallowing function at baseline and the 1-week, 2-week, 1-month, and 3-month follow-ups. A generalized estimating equation (GEE) model revealed the significant main effect for time in UES, PAS, DOSS, FOIS, and SSA compared to baseline (P <0.05), while no group-by-time interactions (except for the PAS assessment) or main effect for treatment was detected among the above multiple variances. No systematic complications or severe adverse effects were noted. Both ultrasound-guided botulinum toxin type A injections and balloon dilatation therapy have been proven as safe and effective treatments for CPD patients. Future clinical trials with longer follow-up periods and more participants are warranted.

Ultrasound-guided five-point injection of botulinum toxin for patients with trapezius hypertrophy

ObjectivesOur study aimed to explore the clinical therapeutic effects of ultrasound-guided five-point injection of botulinum toxin type A for patients with trapezius hypertrophy.MethodsTwenty female patients diagnosed with trapezius hypertrophy were enrolled in this study. The thicknesses of the trapezius muscle were measured by using the ultrasound scanner to locate the thickest point of trapezius, followed by labelling the other four points around the first point. Botulinum toxin type A was injected bilaterally (50 IU/side, 5 points/side) in the trapezius muscle of these patients. The surgery effects were evaluated by thicknesses of the trapezius muscle, intramuscular needle electromyographic and electroneurographic examinations, appearance changes and patients’ satisfactions.ResultsStatistically significant differences in thicknesses of the trapezius muscle were observed at 4 weeks (p < 0.001), 12 weeks (p < 0.001), 20 weeks (p < 0.001), 28 weeks (p = 0.011), 36 weeks (p = 0.022), and 44 weeks (p = 0.032) after surgery. The latencies of trapezius muscle became longer at 12 weeks after surgery (left: 2.40 ms, right: 2.53 ms vs. left: 1.75 ms, right: 2.00 ms). Electroneurographic results showed amplitude reduction of compound muscle action potentials (CMAPs) at 12 weeks after surgery (left: 1.91 uV, right: 3.10 uV vs. left: 15.00 uV, right: 15.40 uV). Obvious appearance changes were revealed at 12 weeks after surgery. All of 80% patients were very satisfied, 15% patients were relatively satisfied, and 5% patients were not satisfied with the surgery.ConclusionUltrasound-guided five-point injection of botulinum toxin type A might be effective for patients with trapezius hypertrophy.

A Systematic Review of the Omohyoid Muscle Syndrome (OMS): Clinical Presentation, Diagnosis, and Treatment Options.

Omohyoid muscle syndrome (OMS) is a condition that causes a X-shaped lateral neck lump on swallowing, caused by the failure of the central tendon of the omohyoid muscle to restrict movement of the muscle during swallowing. We aim to review the etiology, pathophysiology, diagnostic tests, and management options for this condition. Pubmed, MEDLINE, EMBASE, and Cochrane databases were searched for all articles and abstracts related to OMS up to 29th July 2020. A systematic review was performed, data extracted from relevant full text articles. Both quantitative data and qualitative data were analyzed. Twenty cases of OMS were reported. Patients presented at a mean age of 36.0. All cases were Asian. There is a 7:3 ratio of males to females. The most common symptom was a transient neck mass. Most cases were managed conservatively with good prognosis. Open or endoscopic transection of the muscle and ultrasound-guided botulinum toxin injection were 3 treatment options, with no recurrence at 4 years, 6 months, and 6 months respectively. OMS could be genetic as all cases were Asian in ethnicity. The deep cervical fascia which usually envelopes the omohyoid muscle may be weakened by stress as 20% of cases had a preceding traumatic event. Real-time ultrasonography establishes the diagnosis, demonstrating the anterolateral displacement of the sternocleidomastoid muscle by a thickened omohyoid muscle during swallowing. Surgical transection can achieve cure, but due to limited studies available, they should be reserved for patients who are extremely bothered. Intramuscular injection of botulinum toxin is an effective alternative, but recurrence is expected.

Anatomo-sonographic identification of the longissimus capitis and splenius cervicis muscles: principles for possible application to ultrasound-guided botulinum toxin injections in cervical dystonia

ObjectiveThe main objective of this study was to define and verify anatomo-sonographic landmarks for ultrasound-guided injection of botulinum toxin into the longissimus capitis (LC) and splenius cervicis (SC) muscles.Methods and resultsAfter a preliminary work of anatomical description of the LC and SC muscles, we identified these muscles on two cadavers and then on a healthy volunteer using ultrasound and magnetic resonance imaging (MRI) to establish a radio-anatomical correlation. We defined an anatomo-sonographic landmark for the injection of each of these muscles. The correct positioning of vascular glue into the LC muscle and a metal clip into the SC muscle of a fresh cadaver as verified by dissection confirmed the utility of the selected landmarks.DiscussionFor the LC muscle, the intramuscular tendon of the cranial part of the muscle appears to be a reliable anatomical landmark. The ultrasound-guided injection can be performed within the cranial portion of the muscle, between the intra-muscular tendon and insertion into the mastoid process at dens of the axis level. For the SC muscle, the surface topographic landmarks of the spinous processes of the C4–C5 vertebrae and the muscle body of the levator scapulae muscle seem to be reliable landmarks. From these, the ultrasound-guided injection can be carried out laterally by transfixing the body of the levator scapulae.ConclusionThe study defined two cervical anatomo-sonographic landmarks for injecting the LC and SC muscles.

Evaluation of endoscopic ultrasound-guided gastric botulinum toxin injections in the treatment of obesity

BackgroundObesity is rapidly emerging as one of the greatest challenges of human health. Many randomized trials and open-label human studies described conflicting results of gastric intra-muscular injections of botulinum toxin type A (BTA). Endoscopic ultrasound (EUS) guidance can assure BTA injection into the subserosal layer and muscularis propria of the gastric wall which may optimize the efficacy of injection. The aim of the study is to assess the efficacy and safety of EUS-guided gastric BTA injections in weight reduction for obese subjects.ResultsThe present study included 25 patients (2 males and 23 females with mean age 35.84 ± 7.776). For nutrient drink tests, median maximum tolerated volumes (MTVs) decreased from 720 cc (range 480–1680) as a baseline value 2 weeks before BTA injection to 360 cc (range 140–820) at 16 weeks after injection. Mean body weight reduction was 11.92 kg (10.8%) after 16 weeks of BTA injection. Mean body weight continued to decrease during the study period from a baseline value of 110 to 98 kg with significant reduction of mean BMI from baseline value of 41.2 to 36.7 at 16 weeks after BTA injection (p < 0.001). The study was completed without major adverse events.ConclusionEUS-guided BTA injection into the antral subserosa and muscularis propria could be an effective technique for weight reduction, or as a bridge for surgery, which can be done safely with minimal complications.Trial registrationNCT03901040

Accuracy of Ultrasound-Guided and Non-guided Botulinum Toxin Injection Into Neck Muscles Involved in Cervical Dystonia: A Cadaveric Study

ObjectiveTo compare the accuracy of ultrasound-guided and non-guided botulinum toxin injections into the neck muscles involved in cervical dystonia.MethodsTwo physicians examined six muscles (sternocleidomastoid, upper trapezius, levator scapulae, splenius capitis, scalenus anterior, and scalenus medius) from six fresh cadavers. Each physician injected ultrasound-guided and non-guided injections to each side of the cadaver’s neck muscles, respectively. Each physician then dissected the other physician’s injected muscle to identify the injection results. For each injection technique, different colored dyes were used. Dissection was performed to identify the results of the injections. The muscles were divided into two groups based on the difficulty of access: sternocleidomastoid and upper trapezius muscles (group A) and the levator scapulae, splenius capitis, scalenus anterior, and scalenus medius muscles (group B).ResultsThe ultrasound-guided and non-guided injection accuracies of the group B muscles were 95.8% and 54.2%, respectively (p<0.001), while the ultrasound-guided and non-guided injection accuracies of the group A muscles were 100% and 79.2%, respectively (p<0.05).ConclusionUltrasound-guided botulinum toxin injections into inaccessible neck muscles provide a higher degree of accuracy than non-guided injections. It may also be desirable to consider performing ultrasound-guided injections into accessible neck muscles.

Treatment of sialorrhoea with repeated ultrasound-guided injections of botulinum toxin A into the parotid and submandibular glands

Botulinum toxin injections are useful in patients with refractory sialorrhoea although the optimum treatment protocol and its efficacy over a long period of follow up are controversial. The aim of our prospective study was to examine the efficacy and complications of a protocol of repeated ultrasound-guided botulinum toxin injections of fixed doses at a tertiary children’s hospital. A total of 79 procedures were done in 34 patients who were followed up for two years. The overall complication rate was 3%. The outcome measures considered included the Drooling Frequency Severity Scale (DFSS), visual analogue scale (VAS), and carers’ assessments of the reduction in drooling. Our study highlighted two types on non-responders (primary and secondary) of which 3/34 required definitive surgical management. In summary, this study shows that a protocol of repeated injections of fixed doses of botulinum toxin A, while not beneficial in all cases, is a potentially valuable option for the safe and effective treatment of sialorrhoea in children.

Utility of ultrasound-guided injection of botulinum toxin type A for muscle imbalance in children with obstetric brachial plexus palsy: description of the procedure and action protocol

IntroductionObstetric brachial plexus palsy (OBPP) usually has a favourable prognosis. However, nearly one third of all severe cases have permanent sequelae causing a high level of disability. In this study, we explore the effectiveness of ultrasound-guided injection of botulinum toxin A (BoNT-A) and describe the procedure. Patients and methodsWe designed a prospective, descriptive study including patients with moderate to severe OBPP who were treated between January 2010 and December 2014. We gathered demographic data, type of OBPP, and progression. Treatment effectiveness was assessed with the Active Movement Scale (AMS), the Mallet classification, and video recordings. ResultsWe gathered a total of 14133 newborns, 15 of whom had OBPP (1.6 per 1000 live births). Forty percent of the cases had severe OBPP (0.4/1000), a dystocic delivery, and APGAR scores <5; mean weight was 4038g. Mean age at treatment onset was 11.5 months. The muscles most frequently receiving BoNT-A injections were the pronator teres, subscapularis, teres major, latissimus dorsi, and pectoralis major. All the patients who completed the follow-up period (83%) experienced progressive improvements: up to 3 points on the AMS and a mean score of 19.5 points out of 25 on the Mallet classification at 2 years. Treatment improved muscle function and abnormal posture in all cases. Surgery was avoided in 3 patients and delayed in one. Adverse events were mild and self-limited. ConclusionsDue to its safety and effectiveness, BoNT-A may be used off-label as an adjuvant to physical therapy and/or surgery in moderate to severe OBPP. Ultrasound may increase effectiveness and reduce adverse effects.

Ultrasound imaging for sarcopenia, spasticity and painful muscle syndromes.

On the basis of its various advantages and the relevant awareness of physicians, ultrasound imaging has overwhelmingly taken its place in the scientific arena. This is true both from the side of daily clinical applications and also from the side of research. Yet, ultrasound provides real-time (diagnostic) imaging and (interventional) guidance for a wide spectrum of muscle disorders. In this regard, this review aims to discuss the potential/actual utility of ultrasound imaging in particular muscle disorders, that is, sarcopenia, spasticity and fibromyalgia/myofascial pain syndrome. Due to the aging population worldwide and the importance of functionality in the older population, mounting interest has been given to the diagnosis and management of sarcopenia in the recent literature. Likewise, several articles started to report that ultrasound imaging can be used conveniently and effectively in the early diagnosis and quantification of sarcopenia.For spasticity, aside from ultrasound-guided botulinum toxin injections, intriguing attention has been paid to sonographic evaluation of muscle architecture, echogenicity and elasticity in the follow-up of these chronic conditions.As regards painful muscle syndromes, quantitative ultrasound techniques have been shown to detect statistically significant differences between healthy controls and patients with myofascial pain syndrome. Ultrasound imaging seems to be a promising tool that indisputably deserves further research in the management of a wide range of muscle disorders. VIDEO ABSTRACT: http://links.lww.com/COSPC/A17.

Ultrasound-Guided Botulinum Toxin Injections in Cervical Dystonia Needs Prompt Muscle Selection, Appropriate Dosage and Precise Guidance

Ultrasound-Guided Botulinum Toxin Injections in Cervical Dystonia Needs Prompt Muscle Selection, Appropriate Dosage and Precise Guidance

Poster 170: Novel Approach to Ultrasound-Guided Botulinum Toxin Injection of the Medial Pterygoid for Trismus

Poster 170: Novel Approach to Ultrasound-Guided Botulinum Toxin Injection of the Medial Pterygoid for Trismus

'Authorʼs Response to Letter to the Editor On 'Ultrasound-Guided Botulinum Toxin Injections in Cervical Dystonia Needs Prompt Muscle Selection, Appropriate Dosage and Precise Guidance'

'Authorʼs Response to Letter to the Editor On 'Ultrasound-Guided Botulinum Toxin Injections in Cervical Dystonia Needs Prompt Muscle Selection, Appropriate Dosage and Precise Guidance'

Ultrasound-Guided Botulinum Toxin Injection with Factor VIII Administration for Post Stroke Spasticity in a Hemophilia A Patient

Ultrasound-Guided Botulinum Toxin Injection with Factor VIII Administration for Post Stroke Spasticity in a Hemophilia A Patient

Prevalence of Bleeding Complications Following Ultrasound-Guided Botulinum Toxin Injections in Patients on Anticoagulation or Antiplatelet Therapy

BackgroundPatients receiving anticoagulation or antiplatelet therapy may be at higher risk for bleeding complications following intramuscular chemodenervation injections. Musculoskeletal ultrasound may be able to reduce the risk of bleeding complications by providing real-time visualization of vascular structures and postinjection monitoring. Limited data exist addressing the risk of bleeding complications following ultrasound-guided botulinum neurotoxin intramuscular chemodenervation procedures in the setting of anticoagulation or antiplatelet therapy. ObjectiveTo provide initial outcome data regarding bleeding complications in patients on anticoagulation or antiplatelet therapy who have received ultrasound-guided botulinum neurotoxin intramuscular chemodenervation procedures. DesignRetrospective, medical record review. SettingAcademic institution outpatient spasticity clinic. ParticipantsTotal of 328 ultrasound-guided intramuscular botulinum toxin injections performed in 15 patients (mean age 53.8 years) with the predominant indication for chemodenervation being spastic paresis secondary to stroke. MethodsThe medical records of all patients undergoing ultrasound-guided intramuscular chemodenervation procedures performed between July 1, 2011, and October 16, 2015, were reviewed for demographic information, details regarding anticoagulation therapy, procedure specifics, and postinjection bleeding complications. All patients had a postinjection ultrasound to screen for hematoma. Main Outcome MeasuresPrevalence of clinically significant bleeding complications and of sonographically documented subclinical bleeding complications following ultrasound-guided chemodenervation procedures in patients on anticoagulation or antiplatelet therapy. ResultsOf 328 procedures, only 2 subclinical hematomas were detected, resulting in a bleeding complication rate of 0.61% in this patient population. The target muscles in these cases were tibialis posterior and pronator teres, and both cases were in patients on anticoagulation therapy (as opposed to antiplatelet therapy). ConclusionsThe risk of clinically significant bleeding complication appears to be very small following ultrasound-guided intramuscular chemodenervation procedures in the setting of systemic anticoagulation or antiplatelet therapy. Level of EvidenceIV