Ultrasound-guided Injection Of Botulinum Toxin Research Articles

Utilidad del tratamiento con infiltraciones ecoguiadas de toxina botulínica A en el desequilibrio muscular de niños con parálisis obstétrica del plexo braquial. Descripción del procedimiento y protocolo de actuación

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 14 133 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 guided botulinum toxin injections into salivary glands: minimal invasive and safe treatment for drooling

Ultrasound guided botulinum toxin injections into salivary glands: minimal invasive and safe treatment for drooling

Interests of the ultrasound-guidance in the treatment of drooling through botulinum toxin injections, our experience over 10years

To report about our 10years' experience about the treatment of drooling by ultrasound guided botulinum toxin injections. Retrospective monocentric study including all the patients suffering from drooling and treated by ultrasound-guided botulinum toxin injections into the salivary glands between 2004and 2015. The etiology of r drooling, the doses of toxin, the injected glands, the size of the glands measured by ultrasonography, the effectiveness of the treatment and the side effects were assessed. Two hundred and ninety-two injections sessions were performed in 61patients. Exactly 70.5% of patients reported an improvement after the first session. Parkinson's disease was the main etiology of drooling (43% of the patients). Eleven patients reported side effects. The salivary gland volume reduced after treatment in 46% of the patients. The interest of ultrasound-guidance is to make sure about the intraglandular injection, to lower the risk for extraglandular diffusion of the toxin responsible for swallowing disorders and to allow for an adaptation of the doses to the volume of the salivary glands, which may vary during treatment.

Parietal hand pseudodystonia treated with ultrasound-guided botulinum toxin injections

Parietal hand pseudodystonia treated with ultrasound-guided botulinum toxin injections

Ultrasound-guided injection of botulinum toxin in upper limb: Experience of PMR departement

Spasticity of the upper limb is a disabling symptom in patients with vascular hemiplegia, both functionally and orthopedic evolution of these patients. Many treatments exist for spasticity, and botulinum toxin may be an attractive therapeutic alternative, to fight against the often deleterious spasticity. We report a retrospective work of 10 spastic patients treated with ultrasound-guided injection of botulinum toxin into the MPR Casablanca service. Evaluation: before, one month and three months after injection. Evaluation methods: spasticity quantified by the modified Aschwort scale. Analytical assessment (voluntary control, joint assessment, pain related to spasticity) and functional (MIF Barthel, Enjalbert…) of the upper limb interested. The initial score of spasticity was 3 in most observations, voluntary control was rated at 3 in 50% of cases. The ultrasound-guided injection was less painful for our patients that the injection by electrostimulation. After a month of the injection, there was a net decrease of spasticity with parallel improvement of functional parameters. At three months, spasticity has increased by one point in nearly half. Due to its considerable cost, only one patient has benefited from a toxin reinjection 3 months later. Several studies have shown the benefit of treatment with botulinum toxin in the treatment of spasticity in the upper limb and its functional implications. Our results confirm those of the literature, however, the sample size is very small because of the product cost, which is not yet covered by social security funds in Morocco. Botulinum toxin has an interest in spastic upper limb in the patient with vascular hemiplegia and its use should be part of a multidisciplinary approach. Four directions can be used: functional (recover gestures and encourage remaining possibilities to grip), analgesic (limit spontaneous pain during care nursing and during physical therapy), aesthetics (open hand) and hygienic (easy nursing care, and facilitate the establishment of an orthosis). The indication of botulinum toxin must meet specific, customized and realistic targets after analytical and functional assessment of patients. The use of botulinum toxin must be part of a multidisciplinary management and cannot be conceived in isolation.

Safety of Ultrasound-Guided Botulinum Toxin Injections for Sialorrhea as Performed by Pediatric Otolaryngologists.

To evaluate incidence of complications and hospital readmission as a result of ultrasound-guided botulinum toxin injections to manage sialorrhea. Case series with chart review. Children's Hospital of Wisconsin. A case series with chart review was performed of all cases of ultrasound-guided injection of botulinum toxin by pediatric otolaryngologists from March 5, 2010, to September 26, 2014,. Primary outcomes included complications such as dysphagia, aspiration pneumonia, and motor paralysis. Secondary outcomes included hospitalization, intubation, and nasogastric tube placement. There were 48 patients, 111 interventions, and 306 intraglandular injections identified. Botulinum toxin type A and type B were utilized in 4 and 107 operative interventions, respectively. Type A was injected into 4 parotid and 4 submandibular glands, utilizing doses of 20 U per parotid and 30 U per submandibular gland. Type B was injected into 98 parotid and 200 submandibular glands, with average dosing of 923 U per parotid and 1170 U per submandibular gland, respectively. There were 2 instances of subjectively worsening of baseline dysphagia that self-resolved. No cases were complicated by aspiration pneumonia or motor paralysis. No patients required hospital readmission, intubation, or nasogastric tube placement. Prior published data indicated 16% complication incidence with ultrasound-guided injection of botulinum toxin. Our study found a low complication rate (0.6%) with ultrasound-guided injections of botulinum toxin to manage sialorrhea, without cases of aspiration pneumonia or motor paralysis. Of 306 intraglandular injections, there were 2 cases of worsening baseline subjective dysphagia that self-resolved.

The Use of Sonographically Guided Botulinum Toxin Type A (Dysport) Injections Into the Tensor Fasciae Latae for the Treatment of Lateral Patellofemoral Overload Syndrome

Background: Pain in the anterior and lateral parts of the knee during exercise is a common clinical problem for which current management strategies are often unsuccessful. Purpose: To investigate the effect of an ultrasound-guided botulinum toxin (BT) injection into the tensor fasciae latae (TFL), followed by physical therapy, in patients classified with lateral patellofemoral overload syndrome (LPOS) who failed to respond to conventional treatment. Study Design: Case series; Level of evidence, 4. Methods: A total of 45 patients (mean ± SD age, 32.4 ± 8.6 years) who met the inclusion criteria of (1) activity-related anterolateral knee symptoms, (2) symptoms lasting longer than 3 months, (3) a pathological abnormality confirmed by magnetic resonance imaging, and (4) previous failed physical therapy received an ultrasound-guided injection of BT into the TFL followed by physical therapy. Patient-reported outcomes were collected at 5 intervals: before the injection; at 1, 4, and 12 weeks after the injection; and at a mean 5 years after the injection. In 42 patients, relative iliotibial band (ITB) length changes were assessed using the modified Ober test at the first 4 time points. A computational model was run to simulate the effect of TFL weakening on gluteus medius (GMed) activity. Statistical analysis was undertaken using 1-way analysis of variance and paired t tests with Bonferroni post hoc correction. Results: There was a significant improvement in Anterior Knee Pain Scale scores from before the injection (61 ± 15) to 1 (67 ± 15), 4 (70 ± 16), and 12 weeks (76 ± 16) after the injection and in 87% of patients (39/45 patients available for follow-up) at approximately 5 years (from 62.9 ± 15.4 to 87.0 ± 12.5) after the injection (all P < .010). A significant effect on the modified Ober test was identified as a result of the intervention, with an increase in leg drop found at 1 (3° ± 5°), 4 (4° ± 5°), and 12 (7° ± 6°) weeks after the injection compared with before the injection (all P < .010). Simulating a progressive reduction in TFL strength resulted in corresponding increases in GMed activity during gait. Conclusion: An injection of BT into the TFL, combined with physical therapy, resulted in a significant improvement of symptoms in patients with LPOS, which was maintained at 5-year follow-up. This may result from reduced lateral TFL/ITB tension or to an increase in GMed activity in response to inhibition of the TFL.

Postural & striatal deformities in Parkinson`s disease: Are these rare?

Parkinson's disease (PD) is the most common neurodegenerative disease and is characterized by tremor, rigidity and akinesia. Diagnosis is clinical in the majority of the patients. Patients with PD may have stooped posture but some of them develop different types of postural and striatal deformities. Usually these deformities are more common in atypical parkinsonian disorders such as progressive supranuclear palsy and multisystem atrophy. But in many studies it has been highlighted that these may also be present in approximately one third of PD patients leading to severe disability. These include antecollis or dropped head, camptocormia, Pisa syndrome, scoliosis, striatal hands and striatal toes. The pathogenesis of these deformities is a complex combination of central and peripheral influences such as rigidity, dystonia and degenerative skeletal changes. Duration of parkinsonism symptoms is an important risk factor and in majority of the patients these deformities are seen in advanced statge of the disease. The patients with such symptoms may initially respond to dopaminergic medications but if not intervened they may become fixed and difficult to treat. Pain and restriction of movement are most common clinical manifestations and these may mimick symptoms of musculoskeletal disorders like rheumatoid arthritis. Early diagnosis is important as the patients may respond to adjustment in dopaminergic medications. Recent advances such as deep brain stimulation (DBS) and ultrasound guided botulinum toxin injection are helpful in management of these deformities in patients with PD.

Perforator-Guided Drug Injection in the Treatment of Abdominal Wall Pain.

Pain from the abdominal wall can be caused by nerve entrapment, a condition called abdominal cutaneous nerve entrapment syndrome (ACNES). As an alternative to surgery, ACNES may be treated with injection of local anesthetics, corticosteroids, or botulinum toxin at the point of maximal pain. The point of maximal pain was marked on the abdominal skin. Using color Doppler ultrasound, the corresponding exit point of perforating blood vessels through the anterior fascia of the rectus abdominis muscle was identified. Ultrasound-guided injection of botulinum toxin in close proximity to the perforator's exit point was performed below and above the muscle fascia. The technique was used from 2008 to 2014 on 15 patients in 46 sessions with a total of 128 injections without complications. The injection technique provided safe and accurate administration of the drug in proximity to the affected cutaneous nerves. The effect of botulinum toxin on ACNES is beyond the scope of this article. Perforator-guided injection enables precise drug administration at the location of nerve entrapment in ACNES in contrast to blind injections.

Ultrasound-Guided Botulinum Toxin Type A Salivary Gland Injection in Children for Refractory Sialorrhea: 10-Year Experience at a Large Tertiary Children's Hospital

BackgroundSialorrhea is problematic for neurologically impaired children, and botulinum toxin A salivary gland injection has been reported as effective in reducing sialorrhea. This article assesses the success and safety of ultrasound-guided weight-based botulinum toxin A injection for the management of sialorrhea in children. MethodsA total of 111 patients (63 males; 48 females; average age 7 years) with refractory sialorrhea were treated with ultrasound-guided botulinum toxin type A salivary gland injections (144 procedures) from July 1, 2004, to July 1, 2014, using a single weight-based protocol. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data were compared with reported effectiveness and complications using odds ratios. ResultsA total of 144 procedures were performed in 111 patients with refractory sialorrhea. Cerebral palsy was the most common underlying etiology for sialorrhea (29%), whereas others included encephalopathy (5%), anoxic brain injury (4%), and a variety of chromosomal anomalies (5%). There was a 100% technical success rate. Overall treatment effectiveness was 68%. Repeat injections were not associated with increased clinical success. No procedure-related deaths or major complications were identified; the minor complication rate was less than 2%. ConclusionsThe protocol used for ultrasound-guided injection of botulinum toxin A proved to be safe and effective in children suffering from sialorrhea. Image guidance technique may lead to a reduction in rates of adverse events reported in other series. Subsequent procedures do not improve upon initial efficacy.

Treatment of iatrogenic sialoceles and fistulas in the parotid gland with ultrasound-guided injection of botulinum toxin A

of the right condyle. He presented one week after operation with a sialocele and salivary fistula through the healing incision. He was treated using the technique described above with ecently, botulinum toxin A has been recognised as a treatent for hypersalivation.1 The A-type toxin is a 2-chain olypeptide comprising a protease enzyme that attacks one f the fusion proteins at a secretomotor or neuromuscular unction and prevents vesicles from anchoring on to the preynaptic membrane to release acetylcholine. Botulinum toxin reats salivary disorders by interrupting intraparotid autoomic activity. We describe 2 cases of iatrogenic injury to the parotid apsule secondary to retromandibular transparotid access for pen reduction and internal fixation of traumatic fracture of he mandibular condyle. Postoperatively, both patients had ormation of a sialocele and leakage of saliva from a cutaeous fistula to the overlying scar. Both were treated with ltrasound-guided injection of botulinum toxin A (Botox, llergan) to the superficial lobe of the parotid through a 2G needle. The procedures were done using local anaeshetic (1% lidocaine 5 ml/gland) injected around the skin at he intended puncture site and infiltrated around the parotid apsule. The first patient, a man with epilepsy who had sustained ilateral condylar fractures and a fracture of the angle of the andible, presented 3 days after operation with painful, tense ialoceles bilaterally (Fig. 1) and a left cutaneous salivary eak. Aspiration of the sialoceles under ultrasound guidnce was followed immediately by infiltration of 50 units f botulinum toxin A into the superficial lobe taking care to

Ultrasound guided botulinum toxin injection for post operative accessory nerve palsy and supraclavicular neuralgia

Ultrasound guided botulinum toxin injection for post operative accessory nerve palsy and supraclavicular neuralgia

Turkey filet with olive: Relevant phantom model to learn ultrasound-guided botulinum toxin injections

Turkey filet with olive: Relevant phantom model to learn ultrasound-guided botulinum toxin injections

Relief from Ultrasound-Guided Botulinum Toxin Injection after Failed Piriformis Release: A Case Report

PM&RVolume 5, Issue 9S p. S205-S205 Musculoskeletal and Sports Medicine Relief from Ultrasound-Guided Botulinum Toxin Injection after Failed Piriformis Release: A Case Report Michael J. Ingraham MD, Michael J. Ingraham MD Medstar Georgetown University Hospital & National Rehabilitation Hospital, Washington, DC, United StatesSearch for more papers by this authorEric Wisotzky MD, Eric Wisotzky MD Medstar Georgetown University Hospital & National Rehabilitation Hospital, Washington, DC, United StatesSearch for more papers by this authorCynthia G. Pineda MD, Cynthia G. Pineda MD Medstar Georgetown University Hospital & National Rehabilitation Hospital, Washington, DC, United StatesSearch for more papers by this author Michael J. Ingraham MD, Michael J. Ingraham MD Medstar Georgetown University Hospital & National Rehabilitation Hospital, Washington, DC, United StatesSearch for more papers by this authorEric Wisotzky MD, Eric Wisotzky MD Medstar Georgetown University Hospital & National Rehabilitation Hospital, Washington, DC, United StatesSearch for more papers by this authorCynthia G. Pineda MD, Cynthia G. Pineda MD Medstar Georgetown University Hospital & National Rehabilitation Hospital, Washington, DC, United StatesSearch for more papers by this author First published: 17 September 2013 https://doi.org/10.1016/j.pmrj.2013.08.294Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume5, Issue9SSeptember 2013Pages S205-S205 RelatedInformation

Poster 313 A Novel Approach to Treating Spasticity in the Lower Extremity: Ultrasound-Guided Botulinum Toxin Injection of the Psoas and Tibialis Posterior Muscles

Poster 313 A Novel Approach to Treating Spasticity in the Lower Extremity: Ultrasound-Guided Botulinum Toxin Injection of the Psoas and Tibialis Posterior Muscles

Ultrasound-guided injection of botulinum toxin A into the submandibular gland in children and young adults with sialorrhoea

Hypersalivation is a common and distressing complaint in children with neuromuscular disorders such as cerebral palsy. Complications associated with severe drooling include daily changes of clothing, perioral dermatitis, dental problems, dehydration, and aspiration pneumonia, which potentially have a detrimental effect on the quality of life of the patient and carer. In this paper we update our previous work to show the potential benefits of ultrasound-guided injection of botulinum toxin A (BTX-A) into the submandibular gland and report on new patients and follow-up data on the existing group.

Achalasia cardia with esophageal varix managed with endoscopic ultrasound-guided botulinum toxin injection

Achalasia cardia is a motility disorder of the esophagus characterized by failure of relaxation of the lower esophageal sphincter. Nitrates and calcium channel blockers, pneumatic dilatation, botulinum toxin injection and surgical myotomy have been described in literature as possible management options. We present a patient who presented with achalasia and was co-incidentally diagnosed to have cryptogenic cirrhosis with portal hypertension and had esophageal varices. This clinical combination precluded the use of pneumatic dilatation and surgical myotomy. We injected botulinum toxin into the lower esophageal sphincter using a celiac plexus neurolysis needle under endoscopic ultrasound guidance; the clinical response was good.

Ultrasound‐guided botulinum toxin injection: A simple in‐office technique to improve tracheoesophageal speech in postlaryngectomy patients

Pharyngoesophageal spasm is a known entity to cause hypertonic/failed tracheoesophageal speech and is successfully treated by botulinum toxin A injection. However, success of botulinum toxin treatment is based on the accurate localization of the pharyngoesophageal segment. A 65-year-old man who had a laryngectomy using voice prosthesis with hypertonic speech underwent ultrasonographic localization of the hypertonic pharyngoesophageal segment. The ultrasound findings were confirmed using videofluoroscopy. Under ultrasound guidance, botulinum toxin was injected into the hypertonic pharyngoesophageal segment and subsequently voice outcomes were evaluated by a speech language pathologist and the pharyngoesophageal segment was assessed by using an ultrasound scan. The patient had improvement in his postinjection tracheoesophageal puncture speech. Ultrasound scan assessment of the pharyngoesophageal segment showed adequate dilation as compared to the pre-botulinum toxin injection treatment. Ultrasonographic localization of the hypertonic pharyngoesophageal segment and ultrasound-guided botulinum toxin injection is a simple, quick, and relatively cheap method to be used in routine practice.

Acute deterioration of bulbar function after ultrasound-guided botulinum toxin injection for the treatment of sialorrhoea in bulbar amyotrophic lateral sclerosis: a case report

Acute deterioration of bulbar function after ultrasound-guided botulinum toxin injection for the treatment of sialorrhoea in bulbar amyotrophic lateral sclerosis: a case report

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