| Objective:The objective of the present study was designed to evaluate the clinicalvalue of electrical stimulation guidance for botulinum toxin injection.Methods:1. Eight legs from four rabbits, we dissect biceps femoris and the nervesbranches, then select three points(N1, N2, N3) to electrical stimulation espectively, themiddle of the biceps femoris (N1), terminal arborizations of nerves distribution area (N2)and adjacent nerves branches (N3), and investigate the response to the electricalstimulation.2.Forty stroke patients with lower limb spasm were selected, these patientswere randomly assigned into two groups. The manual palpation-guided group(n=20) wasapplied manual palpation-guided technique for location of injection. The electricalstimulation group(n=20) was applied electrical stimulation directing injection, Observedthe accuracy of location targeting muscles by two different location techniques：electricalstimulation, and manual palpation guidance for botulinum toxin injection intogastrocnemius, soleus and posterior tibial muscles. Observed the different parts response toelectrical stimulation, assess the accuracy and impact factors of location motor points oftargeting muscles by electrical stimulation.3. Forty-five stroke patients with spasm wereselected. These patients were divided into the biceps brachii group and lower extremitygroups according to the different spasm parts. In the biceps brachii group (n=35) wasrandomly assigned into electrical stimulation group (n=18) was applied electricalstimulation directing injection, and manual palpation-guided group(n=17)was appliedmanual palpation-guided location, the lower extremity groups group (n=40) was randomlyassigned into electrical stimulation group(n=20)and manual palpation-guided group(n=20). Modified Ashworth Scale (MAS), Intergrated EMG(IEMG), Passive Range Of Motion (PROM), speed of gait and Fugl-Meyer Motor Function Assessment (FMA)weremeasured at base line, and the2nd,4th,8th,12th week after treatment.Results:1. Compared with group N1(2/8), group N2(8/8)and N3(8/8)musclecontracture strengthened significantly.2.The accuracy of manual needle placement forlocation motor points of targeting muscles: in the medial gastrocnemius muscle(93.5%),the lateral gastrocnemius (71.2%), Soleus (64.3%), tibialis posteriors(31.7%).The accuracy of electrical stimulation in the medial gastrocnemius muscle(94.5%), the lateral gastrocnemius(82.9%), Soleus(89.9%),tibialis posteriors(100%). Theresults of muscle contracture strengthened of needle in different parts of targeting musclesby electrical stimulation：Compared with2nd area of medial gastrocnemius muscle, the1tharea of medial gastrocnemius muscle induced high sensitivity to electrical stimulation (P﹤0.05). Compared with2nd area of lateral gastrocnemius muscle, the1th area of lateralgastrocnemius muscle induced high sensitivity to electrical stimulation (P﹤0.05).Compared with1th and3th area of soleus muscle, the2nd area of soleus muscle inducedhigh sensitivity to electrical stimulation(P﹤0.05). However, there was no statisticaldifference between1th and3th area of soleus muscle (P>0.05). No statistical differencebetween1th,2nd and3th area of tibialis posteriors(P>0.05).At the junction of thegastrocnemius and soleus muscle induced co-contraction(13.8%).3.Results of clinicalstudies confirmed that, in the biceps brachii group, the measurement indexes of MAS,IEMG,PROM and FMA all improved significantly after treatment (P<0.05).Comparedwith manual palpation-guided group, the MAS and IEMG at the2nd,4th,8th and12thweek, and PROM at the4th,8th and12th, The FMA at the8th and12th week in electricalstimulation group were improved significantly(P<0.05).In the lower extremity group, themeasurement indexes of MAS, IEMG,PROM，speed of gait and FMA all improvedsignificantly after treatment (P<0.05).Compared with manual palpation-guided group, thePROM at the2nd, the FMA at the12th week in electrical stimulation group were improvedsignificantly(P<0.05). Comparing the trend of variations of measurement indexes duringfollow-up periods in two groups there was no statistical difference(P>0.05). Conclusions: The sensitivity of electrical stimulation were related to the nervebranches, density distribution of terminal arborizations of nerves. Sensitive point byelectrical stimulation can be terminal arborizations of nerves distribution area or adjacentnerves branches area, the sensitive points were not exactly the same as the motor point.Compared with manual palpation-guided location, electrical stimulation location hasgreatly improved the accuracy of locate the targeting muscles muscle, but still some ofsensitive points by electrical stimulation were not in the targeting muscle. Therefore, somesensitive points by electrical stimulation were not the optimal injection sites. Giving motorpoints of fusiform muscle near to motor end plates and concentrate to a particular localmuscles, such as biceps brachii, electrical stimulation location got superior clinical resultsthan manual palpation-guided in treatment of muscle spasticity. For the motor end plateswere diffuse to whole muscle, such as gastrocnemius, soleus and posterior tibial muscle,compared with manual palpation-guided location, the clinical effects of electricalstimulation positioning botox injections was no statistical difference. |
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