Secondary Logo

Institutional members access full text with Ovid®

Botulinum Toxin Type A Injection Into the Gastrocnemius Muscle for Spastic Equinus in Adults With Stroke

A Randomized Controlled Trial Comparing Manual Needle Placement, Electrical Stimulation and Ultrasonography-Guided Injection Techniques

Picelli, Alessandro, MD; Tamburin, Stefano, MD, PhD; Bonetti, Paola, MD; Fontana, Carla, MD; Barausse, Martina, MD; Dambruoso, Francesca, MD; Gajofatto, Francesca, MD; Santilli, Valter, MD; Smania, Nicola, MD

American Journal of Physical Medicine & Rehabilitation: November 2012 - Volume 91 - Issue 11 - p 957–964
doi: 10.1097/PHM.0b013e318269d7f3
Original Research Articles
Buy

Objective The aim of this study was to compare the clinical outcomes of manual needle placement, electrical stimulation, and ultrasonography-guided techniques for botulinum toxin injection into the gastrocnemius of adults with spastic equinus after stroke.

Design After randomization into three groups, each patient received the same dose of botulinum toxin type A into the lateral and medial head of the gastrocnemius muscle (OnabotulinumtoxinA, 100U per head) of the affected leg. The manual needle placement group (n = 15) underwent injections using anatomic landmarks and palpation; the electrical stimulation group (n = 15) received injections with electrical stimulation guidance; and the ultrasonography group (n = 17) was injected under sonographic guidance. The modified Ashworth scale, the Tardieu scale, and the ankle passive range of motion were measured at baseline and 1 mo after injection. Nonparametric statistical analysis was used.

Results One month after injection, the modified Ashworth scale improved better in the ultrasonography group than in the manual needle placement group (P = 0.008). The ankle passive range of motion improved better in the ultrasonography group than in the electrical stimulation (P = 0.004) and manual needle placement (P < 0.001) groups. No difference was found between groups for the Tardieu scale.

Conclusions Ultrasonography-guided injection technique could improve the clinical outcome of botulinum toxin injections into the gastrocnemius of adults with spastic equinus.

From the Neuromotor and Cognitive Rehabilitation Research Center (AP, PB, CF, MB, FD, FG, NS) and Neurology Section (ST), Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona; University of Rome “La Sapienza,” Rome (AP, VS); and Neurological Rehabilitation Unit, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy (NS).

All correspondence and requests for reprints should be addressed to: Nicola Smania, MD, Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Italy, P.le L.A. Scuro, 10. 37134 Verona, Italy.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2012 Lippincott Williams & Wilkins, Inc.