title: Ultrasound-guided botulinum toxin injections in neurology: technique, indications and future perspectives.
abstract: Botulinum toxin (BT) therapy is used in neurology to treat muscle hyperactivity disorders including dystonia, spasticity, cerebral palsy, hemifacial spasms and re-innervation synkinesias as well as exocrine gland hyperactivity disorders. To increase its therapeutic effect and to decrease adverse effects in adjacent tissues, exact BT placement is important. Ultrasonography (US) allows non-invasive, real-time imaging of muscular and glandular tissues and their surrounding structures. It can visualize, guide, and standardize the entire procedure of BT application. Small randomized studies suggest that US-guidance can improve therapeutic efficacy and reduce adverse effects of BT therapy when compared to conventional placement. US-guidance should be used in forearm muscles when functionality is important, and in selected leg muscles. It may be used for targeting distinct neck muscles in cervical dystonia. It is helpful for targeting the salivary glands. Here we review the technique, indications and future developments of US-guidance for BT injection in neurological disorders.
authors.affiliation: Department of Neurology, University of Rostock, Gehlsheimer Str. 20, D-18147, Rostock, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Walter
authors.forename: Dirk
authors.initials: D
authors.lastname: Dressler
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004421:Dystonia / Q000188:drug therapy*; D006801:Humans; D009135:Muscular Diseases / Q000188:drug therapy*; D009462:Neurology / Q000379:methods / Q000639:trends; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D014463:Ultrasonography
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: botulinum toxin; cerebral palsy; dystonia; hypersalivation; needle navigation; placement; spasticity; task-related dystonia; ultrasonography; ultrasound-guidance