Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 1 , Pages 9-16.e2 , January 2009

Botulinum Toxin Dilution and Endplate Targeting in Spasticity: A Double-Blind Controlled Study

Presented as an abstract to the American Neurological Association, October 14, 2002, New York.

  • Jean-Michel Gracies, MD

      Affiliations

    • Department of Neurology, Mount Sinai Medical Center, New York, NY
    • Corresponding Author InformationCorrespondence to Jean-Michel Gracies, MD, Service de Médecine Physique et de Réadaptation, CHU Henri Mondor, 51, av du Maréchal De Lattre De Tassigny, 94010 Créteil, France
  • ,
  • Mara Lugassy, MD

      Affiliations

    • Department of Neurology, Columbia Presbyterian Hospital, New York, NY
  • ,
  • Donald J. Weisz, PhD

      Affiliations

    • Department of Neurosurgery, Mount Sinai Medical Center, New York, NY
  • ,
  • Michele Vecchio, MD

      Affiliations

    • U.O. Physical Medicine and Rehabilitation, Vittorio Emanuele Hospital, Catania, Italy
  • ,
  • Steve Flanagan, MD

      Affiliations

    • Department of Rehabilitation Medicine, Mount Sinai Medical Center, New York, NY
  • ,
  • David M. Simpson, MD

      Affiliations

    • Department of Neurology, Mount Sinai Medical Center, New York, NY

References 

  1. Gracies JM. Pathophysiology of spastic paresis (Part II. The emergence of muscle overactivity). Muscle Nerve. 2005;31:552–571
  2. Shaari CM, Sanders I. Quantifying how location and dose of botulinum toxin injections affect muscle paralysis. Muscle Nerve. 1993;16:964–969
  3. Bigalke H, Wohlfarth K, Irmer A, Dengler R. Botulinum A toxin: dysport improvement of biological availability. Exp Neurol. 2001;168:162–170
  4. Kim HS, Hwang JH, Jeong ST, et al. Effect of muscle activity and botulinum toxin dilution volume on muscle paralysis. Dev Med Child Neurol. 2003;45:200–206
  5. Gracies JM, Simpson D. Focal injection therapy. In:  Hallett M editors. The handbook of clinical neurophysiology. St Louis: Elsevier Science; 2003;p. 651–695
  6. Francisco GE, Boake C, Vaughn A. Botulinum toxin in upper limb spasticity after acquired brain injury: a randomized trial comparing dilution techniques. Am J Phys Med Rehabil. 2002;81:355–363
  7. Lee LR, Chuang YC, Yang BJ, Hsu MJ, Liu YH. Botulinum toxin for lower limb spasticity in children with cerebral palsy: a single-blinded trial comparing dilution techniques. Am J Phys Med Rehabil. 2004;83:766–773
  8. Childers MK, Kornegay JN, Aoki R, Otaviani L, Bogan DJ, Petroski G. Evaluating motor end-plate-targeted injections of botulinum toxin type A in a canine model. Muscle Nerve. 1998;21:653–655
  9. Lapicque L. Has the muscular substance a longer chronaxie than the nervous substance?. J Physiol (Lond). 1931;73:189–214
  10. Zack SI. The motor endplate. Philadelphia: WB Saunders; 1971;
  11. Christensen E. Topography of terminal motor innervation in striated muscles from stillborn infants. Am J Phys Med. 1959;38:65–78
  12. Coers C. Structural organization of the motor nerve endings in mammalian muscle spindles and other striated muscle fibers. Am J Phys Med. 1959;38:166–175
  13. Aquilonius SM, Askmark H, Gillberg PG, Nandedkar S, Olsson Y, Stalberg E. Topographical localization of motor endplates in cryosections of whole human muscles. Muscle Nerve. 1984;7:287–293
  14. Deshpande S, Gormley ME, Carey JR. Muscle fiber orientation in muscles commonly injected with botulinum toxin: an anatomical pilot study. Neurotox Res. 2006;9:115–120
  15. Parratte B, Tatu L, Vuillier F, Diop M, Monnier G. Intramuscular distribution of nerves in the human triceps surae muscle: anatomical bases for treatment of spastic drop foot with botulinum toxin. Surg Radiol Anat. 2002;24:91–96
  16. Lepage D, Parratte B, Tatu L, Vuiller F, Monnier G. Extra- and intramuscular nerve supply of the muscles of the anterior antebrachial compartment: applications for selective neurotomy and for botulinum toxin injection. Surg Radiol Anat. 2005;27:420–430
  17. Kim MW, Kim JH, Yang YJ, Ko YJ. Anatomic localization of motor points in gastrocnemius and soleus muscles. Am J Phys Med Rehabil. 2005;84:680–683
  18. Amirali A, Mu L, Gracies JM, Simpson DM. Anatomical localization of motor endplate bands in the human biceps brachii. J Clin Neuromusc Dis. 2007;9:306–312
  19. Geenen C, Consky E, Ashby P. Localizing muscles for botulinum toxin treatment of focal hand dystonia. Can J Neurol Sci. 1996;23:194–197
  20. Gracies JM, Simpson D. Neuromuscular blockers. Phys Med Rehabil Clin N Am. 1999;10:357–383viii
  21. Chin TY, Nattrass GR, Selber P, Graham HK. Accuracy of intramuscular injection of botulinum toxin A in juvenile cerebral palsy: a comparison between manual needle placement and placement guided by electrical stimulation. J Pediatr Orthop. 2005;25:286–291
  22. Hamjian JA, Walker FO. Serial neurophysiological studies of intramuscular botulinum-A toxin in humans. Muscle Nerve. 1994;17:1385–1392
  23. Sloop RR, Escutin RO, Matus JA, Cole BA, Peterson GW. Dose-response curve of human extensor digitorum brevis muscle function to intramuscularly injected botulinum toxin type A. Neurology. 1996;46:1382–1386
  24. Gracies JM, Marosszeky JE, Renton R, Sandanam J, Gandevia SC, Burke D. Short-term effects of dynamic Lycra splints on upper limb in hemiplegic patients. Arch Phys Med Rehabil. 2000;81:1547–1555
  25. Gracies JM. Physiological effects of botulinum toxin in spasticity. Mov Dis. 2004;19:S120–S128
  26. Tyler HR. Botulinus toxin: effect on the central nervous system of man. Science. 1963;139:847–848
  27. Hultborn H, Jankowska E, Lindstrom S. Recurrent inhibition from motor axon collaterals of transmission in Ia inhibitory pathway to motoneurones. J Physiol (Lond). 1971;215:591–612
  28. Gracies JM, Weisz DJ, Yang BY, Flanagan S, Simpson D. Evidence for increased antagonist strength and movement speed following botulinum toxin injections in spasticity [abstract]. Taken from: Neurology. 2001;56:A3
  29. Yablon SA, Agana BT, Ivanhoe CB, Boake C. Botulinum toxin in severe upper extremity spasticity among patients with traumatic brain injury: an open-labeled trial. Neurology. 1996;47:939–944
  30. Hesse S, Krajnik J, Luecke PT, Jahnke MT, Gregoric M, Mauritz KH. Ankle muscle activity before and after botulinum toxin therapy for lower limb extensor spasticity in chronic hemiparetic patients. Stroke. 1996;27:455–460
  31. Snow BJ, Tsui JK, Bhatt MH, Varelas M, Hashimoto SA, Calne DB. Treatment of spasticity with botulinum toxin: a double blind study. Ann Neurol. 1990;28:512–515
  32. Childers MK, Stacy M, Cooke DL, Stonnington HH. Comparison of two injection techniques using botulinum toxin in spastic hemiplegia. Am J Phys Med Rehabil. 1996;75:462–469
  33. Reiter F, Danni M, Ceravolo MG, Provinciali L. Disability changes after treatment of upper limb spasticity with botulinum toxin. J Neuro Rehab. 1996;10:47–52
  34. Sampaio C, Ferreira JJ, Pinto AA, Crespo M, Ferro JM, Castro-Caldas A. Botulinum toxin type A for the treatment of arm and hand spasticity in stroke patients. Clin Rehabil. 1997;11:3–7
  35. Richardson D, Sheean G, Werring D, et al. Evaluating the role of botulinum toxin in the management of focal hypertonia in adults. J Neurol Neurosurg Psychiatry. 2000;69:499–506
  36. Borg-Stein J, Pine ZM, Miller JR, Brin MF. Botulinum toxin for the treatment of spasticity in multiple sclerosis (New observations). Am J Phys Med Rehabil. 1993;72:364–368
  37. Kirazli Y, On AY, Kismali B, Aksit R. Comparison of phenol block and botulinum toxin type A in the treatment of spastic foot after stroke: a randomized, double-blind trial. Am J Phys Med Rehabil. 1998;77:510–515
  38. Bhakta BB, Cozens JA, Bamford JM, Chamberlain MA. Use of botulinum toxin in stroke patients with severe upper limb spasticity. J Neurol Neurosurg Psychiatry. 1996;61:30–35
  39. Simpson D, Alexander DN, O'Brien CF, et al. Botulinum toxin type A in the treatment of upper extremity spasticity: a randomized, double-blind, placebo-controlled trial. Neurology. 1996;46:1306–1310
  40. Girlanda P, Quartarone A, Sinicropi S, et al. Botulinum toxin in upper limb spasticity: study of reciprocal inhibition between forearm muscles. Neuroreport. 1997;8:3039–3044
  41. Dunne JW, Heye N, Dunne S. Treatment of chronic limb spasticity with botulinum toxin A. J Neurol Neurosurg Psychiatry. 1995;58:232–235
  42. Arens LJ, Leary PM, Goldschmidt RB. Experience with botulinum toxin in the treatment of cerebral palsy. S Afr Med J. 1997;87:1001–1003
  43. DeLateur BJ. A new technique of intramuscular phenol neurolysis. Arch Phys Med Rehabil. 1972;53:179–185
  44. Jones RV, Lambert EH, Sayre GP. Source of type of insertion activity in electromyography with evaluation of histologic method of localization. Arch Phys Med Rehabil. 1955;36:301–310
  45. Buchthal F, Rosenfalck P. Spontaneous electrical activity of human muscle. Electroencephalogr Clin Neurophysiol. 1966;20:321–336
  46. Wiederholt WC. “End-plate noise” in electromyography. Neurology. 1970;20:214–224

 Supported by a research grant from Allergan, Inc.

 A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit on the author or one or more of the authors.

 Reprints are not available from the author.

PII: S0003-9993(08)01499-8

doi: 10.1016/j.apmr.2008.04.030

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 1 , Pages 9-16.e2 , January 2009