TY - JOUR
T1 - Improving botulinum toxin efficiency in treating post-stroke spasticity using 3D innervation zone imaging
AU - Zhang, Chuan
AU - Chen, Yen Ting
AU - Liu, Yang
AU - Magat, Elaine
AU - Gutierrez-Verduzco, Monica
AU - Francisco, Gerard E.
AU - Zhou, Ping
AU - Li, Sheng
AU - Zhang, Yingchun
N1 - Publisher Copyright:
© 2021 World Scientific Publishing Company.
PY - 2021/4
Y1 - 2021/4
N2 - Spasticity is a common post-stroke syndrome that imposes significant adverse impacts on patients and caregivers. This study aims to improve the efficiency of botulinum toxin (BoNT) in managing spasticity, by utilizing a three-dimensional innervation zone imaging (3DIZI) technique based on high-density surface electromyography (HD-sEMG) recordings. Stroke subjects were randomly assigned to two groups: the control group (n = 6) which received standard ultrasound-guided injections, and the experimental group (n = 6) which received 3DIZI-guided injections. The amount of BoNT given was consistent for all subjects. The Modified Ashworth Scale (MAS), compound muscle action potential (CMAP) and muscle activation volume (MAV) from bilateral biceps brachii muscles were obtained at the baseline, 3 weeks, and 3 months after injection. Intra-group and inter-group comparisons of MAS, CMAP amplitude and MAV were performed. An overall improvement in MAS of spastic elbow flexors was observed during the 3-week visit (p < 0.01), yet no statistically significant difference found with intra-group or inter-group analysis. Compared to the baseline, a significant reduction of CMAP amplitude and MAV were observed in the spastic biceps muscles of both groups at 3-week post-injection, and returned to approximate baseline value at 12-week post injection. A significantly higher reduction was found in CMAP amplitude (34.71±5.42% versus 20.92±6.73%, p < 0.01) and MAV (71.51±8.20% versus 44.33±21.81%, p < 0.05) in the experimental group compared to the control group. The study has demonstrated preliminary evidence that precisely directing BoNT to the innervation zones (IZs) localized by 3DIZI leads to a significantly higher treatment efficiency improvement in spasticity management. Results have also shown the feasibility of developing a personalized BoNT injection technique for the optimization of clinical treatment for post-stroke spasticity using proposed 3DIZI technique.
AB - Spasticity is a common post-stroke syndrome that imposes significant adverse impacts on patients and caregivers. This study aims to improve the efficiency of botulinum toxin (BoNT) in managing spasticity, by utilizing a three-dimensional innervation zone imaging (3DIZI) technique based on high-density surface electromyography (HD-sEMG) recordings. Stroke subjects were randomly assigned to two groups: the control group (n = 6) which received standard ultrasound-guided injections, and the experimental group (n = 6) which received 3DIZI-guided injections. The amount of BoNT given was consistent for all subjects. The Modified Ashworth Scale (MAS), compound muscle action potential (CMAP) and muscle activation volume (MAV) from bilateral biceps brachii muscles were obtained at the baseline, 3 weeks, and 3 months after injection. Intra-group and inter-group comparisons of MAS, CMAP amplitude and MAV were performed. An overall improvement in MAS of spastic elbow flexors was observed during the 3-week visit (p < 0.01), yet no statistically significant difference found with intra-group or inter-group analysis. Compared to the baseline, a significant reduction of CMAP amplitude and MAV were observed in the spastic biceps muscles of both groups at 3-week post-injection, and returned to approximate baseline value at 12-week post injection. A significantly higher reduction was found in CMAP amplitude (34.71±5.42% versus 20.92±6.73%, p < 0.01) and MAV (71.51±8.20% versus 44.33±21.81%, p < 0.05) in the experimental group compared to the control group. The study has demonstrated preliminary evidence that precisely directing BoNT to the innervation zones (IZs) localized by 3DIZI leads to a significantly higher treatment efficiency improvement in spasticity management. Results have also shown the feasibility of developing a personalized BoNT injection technique for the optimization of clinical treatment for post-stroke spasticity using proposed 3DIZI technique.
KW - 3D source imaging
KW - Stroke
KW - botulinum toxin
KW - high-density surface electromyography
KW - innervation zone
KW - spasticity
KW - Stroke/complications
KW - Muscle Spasticity/diagnostic imaging
KW - Humans
KW - Treatment Outcome
KW - Neuromuscular Agents/therapeutic use
KW - Botulinum Toxins, Type A/therapeutic use
KW - Electromyography
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U2 - 10.1142/S0129065721500076
DO - 10.1142/S0129065721500076
M3 - Article
C2 - 33438529
AN - SCOPUS:85099552048
SN - 0129-0657
VL - 31
SP - 2150007
JO - International Journal of Neural Systems
JF - International Journal of Neural Systems
IS - 4
M1 - 2150007
ER -