title: Functional impact of different muscle localization techniques for Botulinum neurotoxin A injections in clinical routine management of post-stroke spasticity.
abstract: Treatment options for spasticity include intramuscular botulinum neurotoxin A (BoNT-A) injections. Both ultrasound (US) or electromyographic (EMG) guided BoNT-A injections are employed to isolate muscles. To date, most studies have included patients naïve to BoNT-A or following a prolonged wash out phase.
  
  
  
  To determine the impact of US/EMG guided BoNT-A injections on function in outpatients with spasticity receiving an established re-injection regime.
  
  
  
  Thirty patients post-stroke were investigated in a single-blinded, randomized controlled trial using a cross-over design for the EMG and US and a parallel design for the control group. The Modified Ashworth (MAS), Disability Assessment (DAS), Quality of Life (EQ-5D), self-rating scale and Barthel Index were assessed pre- and post-BoNT-A injections of upper limb muscles by a to the injection technique blinded person.
  
  
  
  MAS improved in arm, finger and upper limb 4 weeks after BoNT-A treatment. The improvement showed no significant differences between the three injection techniques. Barthel Index, DAS and EQ-5D remained unchanged in all groups.
  
  
  
  This pilot study questions the impact of the instrumental guided injection techniques on everyday functionality in a routine clinical setting with established re-injection intervals. Larger trials are warranted with patients who are under long-term treatment on a regular basis.
authors.affiliation: a Department of Neurology , Kiel University , Germany.
authors.forename: Kirsten E
authors.initials: KE
authors.lastname: Zeuner
authors.affiliation: a Department of Neurology , Kiel University , Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Knutzen
authors.affiliation: a Department of Neurology , Kiel University , Germany.
authors.forename: Carina
authors.initials: C
authors.lastname: Kühl
authors.affiliation: a Department of Neurology , Kiel University , Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Möller
authors.affiliation: a Department of Neurology , Kiel University , Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Hellriegel
authors.affiliation: a Department of Neurology , Kiel University , Germany.
authors.forename: Nils G
authors.initials: NG
authors.lastname: Margraf
authors.affiliation: a Department of Neurology , Kiel University , Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.affiliation: b Department of Neurology , Diako Flensburg , Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Stolze
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D011788:Quality of Life; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum neurotoxin; arm spasticity; electromyography; stroke; ultrasound