Boissonnault Ève, Jeon April, Munin Michael C, Filippetti Mirko, Picelli Alessandro, Haldane Chloe, Reebye Rajiv
Faculty of Medicine, Université de Montréal, Montreal, Canada; Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston.
Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh.
Eur J Transl Myol. 2024 May 30;34(2):12397. doi: 10.4081/ejtm.2024.12397.
Botulinum Neurotoxin Type A (BoNT-A) injections using Ultrasound (US) guidance have led to research evaluating changes in muscle architecture. Controversy remains as to what constitutes increased Echo-Intensity (EI) in spastic muscles and whether this may affect outcomes. We aim to provide a narrative review of US muscle architecture changes following Central Nervous System (CNS) lesions and explore their relationship to spasticity. Medline, CINAHL, and Embase databases were searched with keywords: ultrasonography, hypertonia, spasticity, fibrosis, and Heckmatt. Three physicians reviewed the results of the search to select relevant papers. Reviews identified in the search were used as a resource to identify additional studies. A total of 68 papers were included. Four themes were identified, including histopathological changes in spastic muscle, effects of BoNT-A on the muscle structure, available US modalities to assess the muscle, and utility of US assessment in clinical spasticity. Histopathological studies revealed atrophic and fibro-fatty changes after CNS lesions. Several papers described BoNT-A injections contributing to those modifications. These changes translated to increased EI. The exact significance of increased muscle EI remains unclear. The Modified Heckmatt Scale (MHS) is a validated tool for grading muscle EI in spasticity. The use of the US may be an important tool to assess muscle architecture changes in spasticity and improve spasticity management. Treatment algorithms may be developed based on the degree of EI. Further research is needed to determine the incidence and impact of these EI changes in spastic muscles.
使用超声（US）引导进行A型肉毒杆菌神经毒素（BoNT-A）注射引发了对肌肉结构变化的研究评估。对于痉挛性肌肉中回声强度（EI）增加的构成以及这是否会影响治疗效果仍存在争议。我们旨在对中枢神经系统（CNS）损伤后超声下的肌肉结构变化进行叙述性综述，并探讨它们与痉挛的关系。通过关键词“超声检查、张力亢进、痉挛、纤维化和赫克马特”检索了Medline、CINAHL和Embase数据库。三位医生审查了检索结果以选择相关论文。在检索中确定的综述被用作识别其他研究的资源。总共纳入了68篇论文。确定了四个主题，包括痉挛性肌肉的组织病理学变化、BoNT-A对肌肉结构的影响、评估肌肉的可用超声模式以及超声评估在临床痉挛中的效用。组织病理学研究显示中枢神经系统损伤后出现萎缩和纤维脂肪性改变。几篇论文描述了BoNT-A注射导致这些改变。这些变化转化为EI增加。肌肉EI增加的确切意义仍不清楚。改良赫克马特量表（MHS）是一种用于评估痉挛中肌肉EI分级的有效工具。超声的使用可能是评估痉挛中肌肉结构变化和改善痉挛管理的重要工具。可以根据EI程度制定治疗算法。需要进一步研究以确定这些EI变化在痉挛性肌肉中的发生率和影响。
