Effectiveness of Ultrasound-guided VS Electrical-stimulation-guided Botulinum Toxin Injections in Triceps Surae Spasticity after Stroke: A Randomized Controlled Study

Abstract

Objective: To compare the efficacy of botulinum toxin injections using ultrasound-guidance vs electrical-stimulation-guidance in triceps surae (soleus and gastrocnemius) spasticity after stroke. Design: A clinical, single-centre, prospective, interventional, single-blind, cross-over, randomized trial, with outpatients in the tertiary care hospital. After randomization, subjects received electrical-stimulation-guided, followed by ultrasound-guided abobotulinumtoxinA injection (n = 15), or the same 2 procedures in the reverse order (n = 15) with the same operator, 4 months apart. The primary endpoint was the Tardieu scale with the knee straight at 1 month after injection. Results: The 2 groups did not differ in Tardieu scale score (effect size = 0.15, 95% confidence interval (95% CI) –0.22 to 0.51, p = 0.43). In addition, the muscle localization technique used had no influence on walking speed, pain on injection or spasticity, assessed at 1 month after the injection, using the modified Ashworth scale. Ultrasound-guided injections were faster to administer than electrical-stimulation-guided injections. Conclusion: In agreement with previous research, no differences were found in the efficacy of ultrasound-guided or electrical-stimulation-guided abobotulinumtoxinA injections in triceps surae spasticity after stroke. Both techniques are of equal use in guiding muscle localization for botulinum toxin injections in spastic triceps surae. LAY ABSTRACT This study compared the efficacy of 2 techniques used to localize botulinum toxin (BoNT-A) injections in triceps surae (soleus and gastrocnemius) spasticity after stroke: ultrasound-guidance vs electrical-stimulation-guidance. The results show that electrostimulation guidance and ultrasound guidance have the same efficacy for BoNT-A injections in triceps surae spasticity. The technique used had no influence on spasticity, walking speed, or pain on injection. Administration of ultrasound-guided injections was faster than electrical-stimulation-guided injections.

Keywords

• botulinum toxin
• triceps surae
• ultrasonography
• Tardieu scale