Department of Biomedical Engineering, University of Houston, Houston, TX, USA.
Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston and TIRR, Memorial Hermann Hospital, Houston, TX, USA.
Int J Neural Syst. 2021 Apr;31(4):2150007. doi: 10.1142/S0129065721500076. Epub 2021 Jan 12.
Spasticity is a common post-stroke syndrome that imposes significant adverse impacts on patients and caregivers. This study aims to improve the efficiency of botulinum toxin (BoNT) in managing spasticity, by utilizing a three-dimensional innervation zone imaging (3DIZI) technique based on high-density surface electromyography (HD-sEMG) recordings. Stroke subjects were randomly assigned to two groups: the control group ([Formula: see text]) which received standard ultrasound-guided injections, and the experimental group ([Formula: see text]) which received 3DIZI-guided injections. The amount of BoNT given was consistent for all subjects. The Modified Ashworth Scale (MAS), compound muscle action potential (CMAP) and muscle activation volume (MAV) from bilateral biceps brachii muscles were obtained at the baseline, 3 weeks, and 3 months after injection. Intra-group and inter-group comparisons of MAS, CMAP amplitude and MAV were performed. An overall improvement in MAS of spastic elbow flexors was observed during the 3-week visit ([Formula: see text]), yet no statistically significant difference found with intra-group or inter-group analysis. Compared to the baseline, a significant reduction of CMAP amplitude and MAV were observed in the spastic biceps muscles of both groups at 3-week post-injection, and returned to approximate baseline value at 12-week post injection. A significantly higher reduction was found in CMAP amplitude ([Formula: see text]% versus [Formula: see text]%, [Formula: see text]) and MAV ([Formula: see text]% versus [Formula: see text]%, [Formula: see text]) in the experimental group compared to the control group. The study has demonstrated preliminary evidence that precisely directing BoNT to the innervation zones (IZs) localized by 3DIZI leads to a significantly higher treatment efficiency improvement in spasticity management. Results have also shown the feasibility of developing a personalized BoNT injection technique for the optimization of clinical treatment for post-stroke spasticity using proposed 3DIZI technique.
痉挛是一种常见的卒中后综合征，给患者和照护者带来了重大的不良影响。本研究旨在通过利用基于高密度表面肌电图（HD-sEMG）记录的三维神经支配区成像（3DIZI）技术，提高肉毒毒素（BoNT）治疗痉挛的效率。将卒中患者随机分为两组：对照组（[Formula: see text]）接受标准超声引导下注射，实验组（[Formula: see text]）接受 3DIZI 引导下注射。所有患者给予的 BoNT 量相同。在基线、注射后 3 周和 3 个月时，分别测量双侧肱二头肌的改良 Ashworth 量表（MAS）、复合肌肉动作电位（CMAP）和肌肉激活体积（MAV）。对 MAS、CMAP 幅度和 MAV 进行组内和组间比较。在 3 周就诊时，观察到痉挛性肘屈肌的 MAS 总体改善（[Formula: see text]），但组内或组间分析均未发现统计学差异。与基线相比，两组患者注射后 3 周时痉挛肱二头肌的 CMAP 幅度和 MAV 均显著降低，12 周后恢复至接近基线值。实验组 CMAP 幅度（[Formula: see text]%比[Formula: see text]%，[Formula: see text]）和 MAV（[Formula: see text]%比[Formula: see text]%，[Formula: see text]）的降低幅度显著高于对照组。该研究初步证明，将 BoNT 精确引导至 3DIZI 定位的神经支配区（IZs）可显著提高痉挛管理的治疗效果。结果还表明，使用拟议的 3DIZI 技术，为优化卒中后痉挛的临床治疗，开发个性化 BoNT 注射技术是可行的。
