PDF Ultrasound-Guided Chemodenervation Procedures: Text and Atlas

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Start on. Show related SlideShares at end. WordPress Shortcode. Leonidmiler Follow. Full Name Comment goes here. Are you sure you want to Yes No. Be the first to like this. No Downloads. Views Total views. Actions Shares. Embeds 0 No embeds. No notes for slide. Book details 3. Description this book Ultrasound-Guided Chemodenervation Procedures provides a comprehensive multimedia approach to neurotoxin therapy using ultrasound.

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The work also includes a detailed anatomic and pictorial atlas print and DVD , which will be invaluable to clinicians performing procedures with or without ultrasound guidance. The text section of the book is a reference manual, covering conditions and indications, chemodenervation agents, and ultrasound basics including essential physics, machine settings, artifacts, scanning techniques, and procedural guidance techniques.

Additional research is also needed to determine when US is best used with an electrophysiological technique. The following are available online at www. National Center for Biotechnology Information , U. Journal List Toxins Basel v. Toxins Basel. Published online Dec Katharine E. Karp 2. Barbara I. Author information Article notes Copyright and License information Disclaimer. Received Oct 23; Accepted Dec This article has been cited by other articles in PMC.

Associated Data Supplementary Materials toxinss Abstract Injections of botulinum neurotoxins BoNTs are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Keywords: botulinum neurotoxin, botulinum toxin, chemodenervation, guidance, ultrasound, electrical stimulation, electromyography, motor points, anatomic localization. Introduction The purpose of this invited article is to provide a review of ultrasound US guidance techniques for botulinum neurotoxin BoNT chemodenervation procedures including instrumentation, techniques and potential benefits and limitations of instrumented guidance with US.

Table 1 Clinical Applications of Botulinum Toxins. Open in a separate window. Table 2 Guidance methods for chemodenervation procedures. Motor Point Localization A number of anatomical and electrophysiological studies have mapped the location of motor endplates MoEPs in animal and human skeletal muscles [ 26 , 27 , 28 , 29 , 30 , 31 ].

Based on the mechanism of action of BoNT a number of theoretical advantages and potential benefits of MoEP targeting have been suggested including reduced; Variability between treatment sessions Dose needed for efficacy Cost of the procedure by reducing total dose Potential reduction in spread to adjacent muscles or structures Risk of immune resistance In a double blind RCT, Gracies et al.

Sonoacoustic Characteristics of Relevant Tissues: Skeletal muscle: The sonoacoustic appearance of muscle is a mix of hyperechoic intramuscular connective tissue and hypoechoic contractile fascicles. This is most notable in patients with more severe impairments and functional limitations [ 24 ]. Figure 1. Figure 2. Figure 3. Equipment The equipment required to perform US-guided chemodenervation procedures includes [ 24 , 48 , 52 ]. Figure 4. Figure 5. Figure 6. Figure 7. US Guided Procedures Techniques The muscles to be targeted and guidance technique s for a chemodenervation are determined by the treatment plan, which is in turn determined by the patient assessment [ 7 , 8 , 22 ].

Figure 8. Ultrasound Artifacts Anisotropy is one of several important artifacts encountered during US imaging, others being posterior acoustic shadowing, posterior acoustic enhancement, and reverberation. For superficial structures, such as the sternocleidomastoid muscle, this is easily accomplished. This often requires a larger gauge, longer needle. US provides accurate anatomical localization of the needle electrode while EMG provides information about the activity of the muscle and whether there is tonic activity suggesting its contribution to the observed abnormal posture.

EMG may also be used to for localization of motor points which performing neurolytic chemodenervation procedures [ 24 , 57 ]. Video S1. The injection needle electrode, which is used the stimulator setting on an EMG machine or hand-held stimulator, is inserted under US guidance and advanced to a near-nerve location [ 24 , 37 , 55 , 56 ]. The stimulator is turned on and muscle twitch is observed. The needle position is adjusted or advanced while reducing the intensity of the stimulation until an optimal sited is located; the agent is then injected through the same needle.

Current US technology cannot visualize motor points for motor point blocks but US can be used to accurately insert the needle into the selected muscle and the needle position adjusted using the E-Stim or EMG to identify the MoEPs. US guidance alone is not used in isolation for nerve or motor point blocks [ 24 , 55 ] Video S2. Systematic Reviews Chan et al.

Other Articles Injection Pain: Reducing pain associated with BoNT injections is important as many patients, particularly children, report significant discomfort with injections. The authors reported that the time to identify and perform injections under US guidance in the target muscles varied from five s in superficial muscles to 30 s in deep muscles.

The authors also noted that patient cooperation for muscle recruitment was not required for US guided injections [ 44 ]. Based on the results of this study, the authors recommended the use of electrical stimulation or other guidance techniques for needle placement in all muscles excepting gastroc-soleus [ 43 ].

The authors concluded that this limited accuracy was likely due to smaller size or thickness of the lateral head of the gastrocnemius when compared to the medial head [ 41 ]. The incidence of dysphagia was They recommended that injections be placed as near to the motor end-plates as possible, where this information is known, otherwise injection guidance charts should be used. When higher doses are needed for small muscles, higher volumes were not required.

Summary Ultrasound guidance is one of several localization techniques available to guide chemodenervation procedures including BoNT injections. Supplementary Materials The following are available online at www. Click here for additional data file. References 1. Alter K. Comparison of Botulinum Neurotoxin Products.

In: Alter K. Botulinum Neurotoxin Injection Manual. Jankovic J. An update on new and unique uses of botulinum toxin in movement disorders. Lungu C. Seminars in Neurology. Volume Thieme Medical Publishers; Stuttgart, Germany: Simpson D. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology.

Orsini M. Botulinum neurotoxin type A in neurology: Update. Ibrahim O. Seminars in Cutaneous Medicine and Surgery. Update on botulinum neurotoxin use in aesthetic dermatology; pp. Esquenazi A. Botulinum toxin for the management of adult patients with upper motor neuron syndrome. Mayer N. Muscle overactivity and movement dysfunction in the upper motorneuron syndrome. Disease-oriented approach to botulinum toxin use. Bhidayasiri R. Expanding use of botulinum toxin. Giordano C. Injectable and topical neurotoxins in dermatology: Indications, adverse events, and controversies.

Bandeira I. Botulinum toxin type A in the treatment of facial myotonia in Schwartz-Jampel syndrome. Muscle Nerve. Jabbari B. Treatment of refractory pain with botulinum toxins—An evidence-based review. Pain Med. Chhina H. Bhave A. Botulinum toxin type A injections for the management of muscle tightness following total hip arthroplasty: A case series.

Intiso D. Botulinum toxin use in neuro-rehabilitation to treat obstetrical plexus palsy and sialorrhea following neurological diseases: A review. Nagi R. Botulinum toxin in the management of head and neck disorders. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Matak I.

Botulinum toxin A, brain and pain. Campanati A. Skin Appendage Disord. De Maio M. Alliance for the Future of Aesthetics Consensus Committee. Schlessinger J. New Uses of AbototulinumtoxinA in Aesthetics. Elovic E. Chemodenervation and nerve blocks in the diagnosis and management of spasticity and muscle overactivity. Clinical applications, upper motor neuron syndromes. Guidance techniques for botulinum toxins and other injections. In: Alexander M. Pediatric Rehabilitation, Principles and Practice. Comparing guidance techniques for chemodenervation procedures. Crammond D. Neurophysiological mapping of muscle endplate location: Precise targeting improves the efficacy of Botulinum neurotoxin injections.

Coers C. Structural organization of the motor nerve endings in mammalian muscle spindles and other striated muscle fibers. Childers M. Targeting the neuromuscular junction in skeletal muscles. Amirali A. Anatomical localization of motor endplate bands in the human biceps brachii.

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Innervation zones of the upper and lower limb muscles estimated by using multichannel surface EMG. Tokyo ; 29 — Van Campenhout A. Localization of the motor endplate zone in human skeletal muscles of the lower limb: Anatomical guidelines for injection with botulinum toxin. Child Neurol. Gracies J. Botulinum toxin dilution and endplate targeting in spasticity: A double-blind controlled study. Role of motor end plate-targeted Botulinum toxin type A injections in children with cerebral palsy.

Acta Orthop. Motor endplate-targeted botulinum toxin injections of the gracilis muscle in children with cerebral palsy. Botulinum toxin type A injections in the psoas muscle of children with cerebral palsy: Muscle atrophy after motor end plate-targeted injections. Davidson J. Antonakakis J. Ultrasound-guided regional anesthesia for peripheral nerve blocks: An evidence-based outcome review.

Schiano T. Use of high resolution endoscopic ultrasonography to assess esophageal wall damage after balloon dilatation and botulinum toxin injection to treat achalasia. Hong J. Elimination of dysphagia using ultrasound guidance for botulinum toxin injections in cervical dystonia. Kwon J. Botulinum toxin A injection into calf muscles for treatment of spastic equinus in cerebral palsy: A controlled trial comparing sonography and electric stimulation-guided injection techniques: A preliminary report.

Yang E. Accuracy of manual needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography. Schroeder A. Botulinum toxin treatment of children with cerebral palsy—A short review of different injection techniques. Chin T. Accuracy of intramuscular injection of botulinum toxin A in juvenile cerebral palsy: A comparison between manual needle placement and placement guided by electrical stimulation. Berweck S. Sonography-guided injection of botulinum toxin in children with cerebral palsy [letter to the editor] Lancet. Walter U.

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Ultrasound-guided botulinum toxin injections in neurology: Technique, indications and future perspectives. Expert Rev. Sikdar S. Physics of ultrasound imaging. Smith J. Diagnostic and interventional musculoskeletal ultrasound: Part 1. Chemodenervation: Ultrasound characteristics of relevant tissues. Diagnostic and interventional musculoskeletal ultrasound: Part 2. Clinical applications. Strakowski J. Ultrasound evaluation of peripheral nerves; pp. Instrumentation and knobology. Introduction to High-Frequency Ultrasound; pp. Scanning techniques and tips. Ultrasound guidance for nerve and motor point blocks.

Bohart Z. Phenol nerve blocks. Jordan S.

Chemodenervation with phenol and US-guided botulinum toxin inj_Eng Sub

Combining ultrasonography and electromyography for botulinum chemodenervation treatment of thoracic outlet syndrome: Comparison with fluoroscopy and electromyography guidance. Pain Phys. Chan A. Does the method of botulinum neurotoxin injection for limb spasticity affect outcomes? A systematic review. Picelli A. Botulinum toxin injection into the forearm muscles for wrist and fingers spastic overactivity in adults with chronic stroke: A randomized controlled trial comparing three injection techniques.

Grigoriu A.

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Impact of injection-guiding techniques on the effectiveness of botulinum toxin for the treatment of focal spasticity and dystonia: A systematic review. Seminars in Arthritis and Rheumatism. Ultrasound-guided versus landmark in knee Arthrocentesis: A systematic review; pp. Ultrasound-guided versus blind subacromial-subdeltoid bursa injection in adults with shoulder pain: A systematic review and meta-analysis; pp.

Brochard S. Effectiveness of nitrous oxide and analgesic cream lidocaine and prilocaine for prevention of pain during intramuscular botulinum toxin injections in children.

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Determining the technical and clinical factors associated with pain for children undergoing botulinum toxin injections under nitrous oxide and anesthetic cream. High-frequency ultrasound guidance for neurotoxin injections. Bayon-Mottu M. Pain during injections of botulinum toxin in children: Influence of the localization technique. Wissel J. European consensus table on the use of botulinum toxin type A in adult spasticity.

Albanese A. Practical guidance for CD management involving treatment of botulinum toxin: A consensus statement. Heinen F. European consensus table on botulinum toxin for children with cerebral palsy. Support Center Support Center. External link.