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Chapter 16 - The Role of Ultrasound for Botulinum Neurotoxin Injection in childhood Spasticity

Published online by Cambridge University Press:  02 November 2023

By
Bettina Westhoff
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett ,
Christopher Zachary  and
Mayank Pathak
Daniel Truong
Affiliation:
University of California, Riverside
Dirk Dressler
Affiliation:
Hannover Medical School
Mark Hallett
Affiliation:
National Institutes of Health (NIH)
Christopher Zachary
Affiliation:
University of California, Irvine
Mayank Pathak
Affiliation:
Truong Neuroscience Institute
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Summary

Botulinum neurotoxin (BoNT) injections are established as a standard procedure for the treatment of muscles in spastic or dystonic children. Superficial and palpable muscles are easy to inject. In contrast, exact needle placement is more difficult and less controllable in deep muscles or those that are small and difficult to selectively identify. Exact needle placement is, however, essential for optimal functional result, avoidance of side effects and evaluation of therapeutic failures. However, clinical application of BoNT without guidance techniques has been shown to be inaccurate. Several techniques are available to guide needle placement for injection. Electromyography is good, but many muscles may be simultaneously active. Electrical stimulation is uncomfortable and painful and often requires anesthesia. CT guidance necessitates exposure to radiation and is costly. By comparison, the advantages of the ultrasound-guided technique are obvious: real-time observation of the injection readily available easily applicable after a manageable learning period cost effective no serious side effects.

This chapter details the use of ultrasound for injection guidance, and discusses indirect and real-time techniques, and both parallel and perpendicular orientations, for needle placement.

Keywords

Childhood spasticitybotulinum neurotoxinBoNTultrasound guidancecerebral palsypediatric spasticity
Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 120 - 124
Publisher: Cambridge University Press
Print publication year: 2023

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References

Berweck, S, Heinen, F (2005). Blue Book. Treatment of Cerebral Palsy with Botulinum Toxin. Principles, Clinical Practice, Atlas, 2nd ed. Berlin: Child & Brain.Google Scholar
Campenhout, A, Hubens, G, Fagard, K, Molenaers, G (2010). Localization of motor nerve branches of the human psoas muscle. Muscle Nerve, 42, 202–7.Google ScholarPubMed
Campenhout, A, Molenaers, G (2011). Localization of the motor endplate zone in human skeletal muscles of the lower limb: anatomical guidelines for injection with botulinum toxin. Dev Med Child Neurol, 53, 108–19.Google Scholar
Chin, T, Nattrass, G, Selber, P et al. (2005). Accuracy of intramuscular injection of botulinum toxin A in juvenile cerebral palsy: a comparison between manual needle placement and placement guided by electrical stimulation. J Pediatr Orthop, 25, 286–91.Google Scholar
Kara, M, Kaymak, B, Ulasli, AM et al. (2018). Sonographic guide for botulinum toxin injections of the upper limb: EUROMUSCULUS/USPRM spasticity approach. Eur J Phys Rehabil Med, 54, 469–85.CrossRefGoogle ScholarPubMed
Kaymak, B, Kara, M, Tok, F et al. (2018). Sonographic guide for botulinum toxin injections of the lower limb: EUROMUSCULUS/USPRM spasticity approach. Eur J Phys Rehabil Med, 54, 486–98.CrossRefGoogle ScholarPubMed
Westhoff, B, Seller, K, Wild, A, Jäger, M, Krauspe, R (2003). Ultrasound-guided botulinum toxin injection technique for the iliopsoas muscle. Dev Med Child Neurol, 45, 829–32.Google Scholar
Zamorani, MP, Valle, M (2007). Muscle and tendon. In Bianchi, S, Martinoli, C (eds.) Ultrasound of the Musculoskeletal System. Berlin: Springer, pp. 46–50.Google Scholar

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